Sympathoadrenal Activation is Associated with Acute Traumatic Coagulopathy and Endotheliopathy in Isolated Brain Injury

BACKGROUND:Acute coagulopathy after traumatic brain injury (TBI) involves a complex multifactorial hemostatic response that is poorly characterized. ObjectivesTo examine early posttraumatic alterations in coagulofibrinolytic, endothelial, and inflammatory blood biomarkers in relation to sympathetic...

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Published in:	Shock (Augusta, Ga.) Vol. 46; no. 3S Suppl 1; pp. 96 - 103
Main Authors:	Di Battista, Alex P, Rizoli, Sandro B, Lejnieks, Brandon, Min, Arimie, Shiu, Maria Y, Peng, Henry T, Baker, Andrew J, Hutchison, Michael G, Churchill, Nathan, Inaba, Kenji, Nascimento, Bartolomeu B, de Oliveira Manoel, Airton Leonardo, Beckett, Andrew, Rhind, Shawn G
Format:	Journal Article
Language:	English
Published:	United States by the Shock Society 01-09-2016 Lippincott Williams & Wilkins
Subjects:	Biomarkers - blood Blood Coagulation Disorders - blood Blood Coagulation Disorders - pathology Brain Injuries - blood Brain Injuries - pathology Brain Injuries, Traumatic - blood Brain Injuries, Traumatic - pathology Catecholamines - blood Clinical Aspects Enzyme-Linked Immunosorbent Assay Humans Injury Severity Score Prospective Studies Regression Analysis Syndecan-1 - blood Thrombomodulin - blood
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Summary:	BACKGROUND:Acute coagulopathy after traumatic brain injury (TBI) involves a complex multifactorial hemostatic response that is poorly characterized. ObjectivesTo examine early posttraumatic alterations in coagulofibrinolytic, endothelial, and inflammatory blood biomarkers in relation to sympathetic nervous system (SNS) activation and 6-month patient outcomes, using multivariate partial least-squares (PLS) analysis. PATIENTS AND METHODS:A multicenter observational study of 159 adult isolated TBI patients admitted to the emergency department at an urban level I trauma center, was performed. Plasma concentrations of 6 coagulofibrinolytic, 10 vascular endothelial, 19 inflammatory, and 2 catecholamine biomarkers were measured by immunoassay on admission and 24 h postinjury. Neurological outcome at 6 months was assessed using the Extended Glasgow Outcome Scale. PLS-discriminant analysis was used to identify salient biomarker contributions to unfavorable outcome, whereas PLS regression analysis was used to evaluate the covariance between SNS correlates (catecholamines) and biomarkers of coagulopathy, endotheliopathy, and inflammation. RESULTS:Biomarker profiles in patients with an unfavorable outcome displayed procoagulation, hyperfibrinolysis, glycocalyx and endothelial damage, vasculature activation, and inflammation. A strong covariant relationship was evident between catecholamines and biomarkers of coagulopathy, endotheliopathy, and inflammation at both admission and 24 h postinjury. CONCLUSIONS:Biomarkers of coagulopathy and endotheliopathy are associated with poor outcome after TBI. Catecholamine levels were highly correlated with endotheliopathy and coagulopathy markers within the first 24 h after injury. Further research is warranted to characterize the pathogenic role of SNS-mediated hemostatic alterations in isolated TBI.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1073-2322 1540-0514
DOI:	10.1097/SHK.0000000000000642