Older females have increased mortality after trauma as compared to younger females and males, associated with increased fibrinolysis-Reference-Cited by-同舟云学术

Older females have increased mortality after trauma as compared to younger females and males, associated with increased fibrinolysis

Published:2023-12-08 Issue: Volume: Page:
ISSN:2163-0763
Container-title:Journal of Trauma and Acute Care Surgery
language:en
Short-container-title:J Trauma Acute Care Surg

Author:

Dujardin R.W.G.^ORCID,Kleinveld D.J.B.,van den Brom C.E.,Geeraedts L.M.G.¹,Beijer E.,Gaarder C.²,Brohi K.³,Stanworth S.⁴,Johansson P.I.⁵,Stensballe J.⁵,Maegele M.⁶,Juffermans N. P.

Affiliation:

1. Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Surgery, Boelelaan 1117, Amsterdam, the Netherlands

2. Department of Traumatology, Oslo University Hospital, Oslo, Norway

3. Trauma sciences, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom

4. NHS Blood and Transplant/Oxford University Hospital NHS trust, John Radcliffe Hospital, Oxford, United Kingdom, Radcliffe Department of Medicine, University of Oxford, United Kingdom

5. Department of Anesthesiology and Trauma Center, Center for Head and Orthopedics, and Section for Transfusion medicine, Capital Region Blood Bank, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark

6. Department of Traumatology and Orthopedic Surgery, Cologne- Merheim Medical Center, University of Witten/Herdecke, Cologne, Germany

Abstract

Abstract Introduction Female sex may provide a survival benefit after trauma, possibly attributable to protective effects of estrogen. This study aims to compare markers of coagulation between male and female trauma patients across different ages. Methods Secondary analysis of a prospective cohort study at six trauma centers. Trauma patients presenting with full trauma team activation were eligible for inclusion. Patients with a penetrating trauma or traumatic brain injury were excluded. Upon hospital arrival, blood was drawn for measurement of endothelial and coagulation markers and for rotational thromboelastometry (ROTEM) measurement. Trauma patients were divided into four categories: males <45 years, males ≥45 years, females <45 years and females ≥45 years. In a sensitivity analysis, patients between 45 – 55 years were excluded to control for menopausal transitioning. Groups were compared with a Kruskall-Wallis test with Bonferroni correction. A logistic regression was performed to assess whether the independent effect of sex and age on mortality. Results 1345 patients were available for analysis. Compared to the other groups, mortality was highest in females ≥45, albeit not independent from injury severity and shock. In the group of females ≥45 there was increased fibrinolysis, demonstrated by increased levels of plasmin-antiplasmin complexes with a concomitant decrease in α2-antiplasmin. Also, a modest decrease in coagulation factors II and X was observed. Fibrinogen levels were comparable between groups. The sensitivity analysis in 1104 patients demonstrated an independent relationship between female sex and age ≥ 55 years and mortality. ROTEM profiles did not reflect the changes in coagulation tests. Conclusion Female trauma patients past their reproductive age have an increased risk of mortality compared to younger females and males, associated with augmented fibrinolysis and clotting factor consumption. ROTEM parameters did not reflect coagulation differences between groups. Level of evidence Level III prognostic and epidemiological data

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Critical Care and Intensive Care Medicine,Surgery