Prothrombin time predicting time-dependent and risk-stratified mortality in polytrauma patients
Abstract Background Polytrauma is associated with a high mortality rate and often accompanied by coagulopathy. Prothrombin time (PT) is a prognostic factor for mortality in polytrauma patients. The aim was to analyze the time- and severity-dependent role of PT in polytrauma patients related to morta...
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BMC
2025-04-01
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| Series: | International Journal of Emergency Medicine |
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| Online Access: | https://doi.org/10.1186/s12245-025-00841-3 |
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| author | Philipp Vetter Cédric Niggli Jan Hambrecht Daniel Haschtmann Hans-Christoph Pape Ladislav Mica |
| author_facet | Philipp Vetter Cédric Niggli Jan Hambrecht Daniel Haschtmann Hans-Christoph Pape Ladislav Mica |
| author_sort | Philipp Vetter |
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| description | Abstract Background Polytrauma is associated with a high mortality rate and often accompanied by coagulopathy. Prothrombin time (PT) is a prognostic factor for mortality in polytrauma patients. The aim was to analyze the time- and severity-dependent role of PT in polytrauma patients related to mortality. Methods Patients (≥ 16 years) with an Injury Severity Score ≥ 16 were retrospectively included, yielding 2890 cases after exclusion criteria. PT was measured at admission and 1, 2, 3, 4, 6, 8, 12, 24, and 48 h thereafter, reported as percentage activity of the reference reagence [%]. According to survival status, two groups were formed and compared. Binary logistic regression was used to test PT as an independent predictor for mortality. A closest top-left threshold method served for calculating threshold values between the survivor and non-survivor group. Patients were divided into subgroups according to PT levels and mortality was assessed for each subgroup at each time point. Results PT values in the non-survivor group were lower throughout the measuring period (p < 0.05). PT threshold values declined from admission until 2 h afterwards, reaching less than 50%. Already a slightly compromised PT (≤ 70%) represented a significant factor (p < 0.05) for mortality at early and late time points, associated with a rate of more than 20%. In extremis, PT values of ≤ 25% were related to a mortality rate of more than 50% up to four hours after admission. Conclusion There are early and significant differences in mortality according to PT values in polytrauma patients (despite resuscitation measures), urging for a fast correction of PT. Time-dependent and stratified referencing may help clinicians estimate the mortality risk and decide upon the extent of surgical care. |
| format | Article |
| id | doaj-art-cbca8b32f2be4d2aa3cb554be42bbb05 |
| institution | DOAJ |
| issn | 1865-1380 |
| language | English |
| publishDate | 2025-04-01 |
| publisher | BMC |
| record_format | Article |
| series | International Journal of Emergency Medicine |
| spelling | doaj-art-cbca8b32f2be4d2aa3cb554be42bbb052025-08-20T03:08:02ZengBMCInternational Journal of Emergency Medicine1865-13802025-04-0118111010.1186/s12245-025-00841-3Prothrombin time predicting time-dependent and risk-stratified mortality in polytrauma patientsPhilipp Vetter0Cédric Niggli1Jan Hambrecht2Daniel Haschtmann3Hans-Christoph Pape4Ladislav Mica5Department of Trauma Surgery, University Hospital ZurichDepartment of Trauma Surgery, University Hospital ZurichDepartment of Trauma Surgery, University Hospital ZurichDepartment of Spine Surgery, Schulthess ClinicDepartment of Trauma Surgery, University Hospital ZurichDepartment of Trauma Surgery, University Hospital ZurichAbstract Background Polytrauma is associated with a high mortality rate and often accompanied by coagulopathy. Prothrombin time (PT) is a prognostic factor for mortality in polytrauma patients. The aim was to analyze the time- and severity-dependent role of PT in polytrauma patients related to mortality. Methods Patients (≥ 16 years) with an Injury Severity Score ≥ 16 were retrospectively included, yielding 2890 cases after exclusion criteria. PT was measured at admission and 1, 2, 3, 4, 6, 8, 12, 24, and 48 h thereafter, reported as percentage activity of the reference reagence [%]. According to survival status, two groups were formed and compared. Binary logistic regression was used to test PT as an independent predictor for mortality. A closest top-left threshold method served for calculating threshold values between the survivor and non-survivor group. Patients were divided into subgroups according to PT levels and mortality was assessed for each subgroup at each time point. Results PT values in the non-survivor group were lower throughout the measuring period (p < 0.05). PT threshold values declined from admission until 2 h afterwards, reaching less than 50%. Already a slightly compromised PT (≤ 70%) represented a significant factor (p < 0.05) for mortality at early and late time points, associated with a rate of more than 20%. In extremis, PT values of ≤ 25% were related to a mortality rate of more than 50% up to four hours after admission. Conclusion There are early and significant differences in mortality according to PT values in polytrauma patients (despite resuscitation measures), urging for a fast correction of PT. Time-dependent and stratified referencing may help clinicians estimate the mortality risk and decide upon the extent of surgical care.https://doi.org/10.1186/s12245-025-00841-3Watson trauma pathway explorerTraumaCoagulopathy |
| spellingShingle | Philipp Vetter Cédric Niggli Jan Hambrecht Daniel Haschtmann Hans-Christoph Pape Ladislav Mica Prothrombin time predicting time-dependent and risk-stratified mortality in polytrauma patients International Journal of Emergency Medicine Watson trauma pathway explorer Trauma Coagulopathy |
| title | Prothrombin time predicting time-dependent and risk-stratified mortality in polytrauma patients |
| title_full | Prothrombin time predicting time-dependent and risk-stratified mortality in polytrauma patients |
| title_fullStr | Prothrombin time predicting time-dependent and risk-stratified mortality in polytrauma patients |
| title_full_unstemmed | Prothrombin time predicting time-dependent and risk-stratified mortality in polytrauma patients |
| title_short | Prothrombin time predicting time-dependent and risk-stratified mortality in polytrauma patients |
| title_sort | prothrombin time predicting time dependent and risk stratified mortality in polytrauma patients |
| topic | Watson trauma pathway explorer Trauma Coagulopathy |
| url | https://doi.org/10.1186/s12245-025-00841-3 |
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