HYPOPERFUSION IS NOT ESSENTIAL FOR THE PATHOGENESIS OF DISSEMINATED INTRAVASCULAR COAGULATION IN PATIENTS WITH ISOLATED SEVERE TRAUMATIC BRAIN INJURY

Abstract

  Introduction : Disseminated intravascular coagulation (DIC) is often complicated in patients with traumatic brain injury (TBI), and one of the main determination factor of poor prognosis. We tried to clarify the effects of systemic tissue hypoperfusion on the pathogenesis of DIC in patients with isolated TBI and those with extra–cranial blunt trauma without TBI. Methods : In the JOCTET, a multicenter, retrospective observational study, data were collected from trauma patients, age≧18 years and with ISS≧16. From the database, we selected patients with isolated TBI (TBI group) as patients with head abbreviated injury score (AIS) ≥4 and extra–cranial AIS<2, and extra–cranial trauma patients (non–TBI group) as patients with extra–cranial AIS≥3 and head AIS<2. Results : TBI group and non–TBI group included 160, and 186 patients, respectively. No correlations were observed between lactate levels on arrival, as a marker of systemic hypoperfusion, and hemostatic variables in TBI group. However, in the non–TBI group, lactate levels correlated with coagulation variables. Stepwise logistic regression analysis showed that lactate level was independent predictor of DIC in non–TBI group. In contrast, no relationship was observed between lactate level and DIC in TBI group. Conclusions : DIC may be complicated in patients with isolated TBI independent with systemic tissue hypoperfusion.