Endotheliopathy of trauma is an on-scene phenomenon, and is associated with multiple organ dysfunction syndrome: a prospective observational study

David N Naumann, Jon Hazeldine, David J Davies, Jon Bishop, Mark J Midwinter, Antonio Belli, Paul Harrison, Janet M Lord

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34 Citations (Scopus)
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Abstract

BACKGROUND: Trauma patients are vulnerable to coagulopathy and inflammatory dysfunction associated with endotheliopathy of trauma (EoT). In vitro evidence has suggested that tranexamic acid (TXA) may ameliorate endotheliopathy. We aimed to investigate how soon after injury EoT occurs, its association with multiple organ dysfunction syndrome (MODS), and whether TXA ameliorates it.

METHODS: A prospective observational study included 91 trauma patients enrolled within 60 minutes of injury and 19 healthy controls. Blood was sampled on enrolment and again 4-12 hours later. ELISAs measured serum concentrations of syndecan-1 and thrombomodulin as biomarkers of EoT. MODS was compared between groups according to biomarker dynamics: (a) persistently abnormal; (b) abnormal to normal; and (c) persistently normal. Timing of EoT was estimated by plotting biomarker data against time, and then fitting generalized additive models. Biomarker dynamics were compared between those who did or did not received prehospital TXA.

RESULTS: Median age was 38 (IQR 24-55) years; 78/91 were male. Median injury severity score (ISS) was 22 (IQR 12-36). EoT was estimated to occur at 5-8 minutes after injury. There were no significant differences in ISS between those with or without prehospital EoT. 42 patients developed MODS; 31/42 with persistently abnormal; 8/42 with abnormal to normal; and 3/42 with persistently normal biomarkers; p < 0.05. There were no significant differences between TXA and non-TXA groups.

CONCLUSIONS: EoT was present at the scene of injury. MODS was more likely when biomarkers of EoT were persistently raised. There were no significant differences between TXA and no TXA groups. Prehospital interventions aimed at endothelial restoration may represent a clinically meaningful target for prehospital resuscitation.

Original languageEnglish
Pages (from-to)420-428
Number of pages29
JournalShock
Volume49
Issue number4
Early online date22 Sep 2017
DOIs
Publication statusPublished - 1 Apr 2018

Keywords

  • endotheliopathy
  • endothelium
  • glycocalyx
  • prehospital
  • syndecan-1
  • thrombomodulin
  • trauma

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