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Glycocalyx Shedding as a Potential Driver of Trauma-induced Coagulopathy in Severe Trauma Patients: Insights from the TRAUCC Trial

M. Desvages1,2, F. Lassalle1,2, D. Garrigue3,4, F. Machuron5, A. Duhamel5, M. Didelot2, B. Vaast1,2, A. Rauch1,2, A. Hochart1, B. Bijok3,4, A. Godier6,7, S. Susen1,2

1Hematology Transfusion, CHU Lille, Lille, France, 2INSERM U1011-EGID, University of Lille, Lille, France, 3Department of Anaesthesiology and Intensive Care, CHU Lille, Lille, France, 4Emergency Department, CHU Lille, Lille, France, 5EA 2694 - Santé Publique: Epidémiologie et Qualité des Soins, CHU Lille, University of Lille, Lille, France, 6Department of Anaesthesiology and Intensive Care, Fondation Ophtalmologique Adolphe de Rothschild, Paris, France, 7INSERM UMR-S1140, University of Paris, Paris, France

Abstract Number: PB1134

Meeting: ISTH 2020 Congress

Theme: Hemophilia and Rare Bleeding Disorders » Management of Bleeding and Trauma

Background: Massive bleeding is a major cause of early death after trauma. One third of bleeding patients have trauma-induced coagulopathy, which increases severity of bleeding and mortality. Trauma-induced endotheliopathy consists of a glycocalyx degradation and shedding and an activation of endothelium leading to endothelial secretion. It can contribute to massive bleeding and death.

Aims: To assess the presence of glycocalyx shedding and endothelial damage on admission of trauma patients and determine the association of these endothelial dysfunctions with coagulopathy, severity of traumatic injury and 30-day mortality.

Methods: Endothelial markers were explored in 41 trauma patients from the TRAUCC trial, using blood samples collected at hospital admission. Glycocalyx shedding was quantified by soluble Syndecan-1 (sCD138). Endothelial secretion was quantified by Angiopoitein-2 (Ang-2). Injury Severity Score (ISS) estimated severity of traumatic injury, and ISS>25 defined the most severe patients. Prothrombin ratio (PTr) >1.2 defined coagulopathy. Relationship between sCD138, aPTT, and thrombin time (TT) were investigated to explore its anticoagulant effect.

Results: Patients who died within 30 days (n=11) have a higher concentration of Ang-2 (p=0.034) (Table I). Patients with an ISS>25 (n=20) have increased concentrations of sCD138 (p=0.001) and Ang-2 (p=0.002) when compared to those with ISS≤25 (n=21). A coagulopathy was present at admission in 26 patients. The levels of sCD138, but not the levels of Ang-2 were increased (p=0.011) in the presence of coagulopathy. aPTT and TT were closely correlated with sCD138 (spearman rs=0.73 and rs=0.72 respectively) (Figure I). We found no relation between coagulation parameters and Ang-2.

Conclusions: Trauma patients had endothelial dysfunctions correlated to injury severity at admission. The secretion of Ang-2 after trauma was correlated to mortality regardless of the presence of a coagulopathy. Glycocalyx shedding seems deeply associated with coagulopathy and this could suggest a causal relation between alteration of coagulation and endothelial damage.

  Survival (n=30) Death (n=11) p value ISS≤25 (n=21) ISS>25 (n=20) p value PTr≤1,2 (n=15) PTr>1,2 (n=26) p value
Severity of trauma
ISS 22 (16-28) 36 (27-45) <0.0001 17 (14-22) 33 (28-38)   16 (14-29) 27 (22-34) 0.022
Coagulopathy
TQr 1.4 (1.1-1.5) 1.5 (1.3-1.9) 0.027 1.2 (1.1-1.4) 1.6 (1.3-1.9) 0.001 1.1 (1.1-1.2) 1.5 (1.4-1.8)  
Endotheliopathy
sCD138 (ng/mL) 62.4 (33.3-118.3) 74.1 (44.9-574.3) 0.26 40.1 (24.2-67.1) 106.7 (57.6-182.0) 0.001 33.6 (23.2-74.1) 89.5 (47.8-168.4) 0.011
Ang-2 (pg/mL) 263 (152-391) 482 (316-776) 0.034 232 (126-338) 441 (298-746) 0.002 242 (154-405) 352 (154-519) 0.19

[sCD138, Ang-2 levels according to mortality, severity of trauma and presence of coagulopathy.]


[Correlations between sCD138 and clotting times; A: aPTT (rs=0.73; p<0.0001) (n=41); B: TT (rs=0.72; p<0.0001) (n=36)]

To cite this abstract in AMA style:

Desvages M, Lassalle F, Garrigue D, Machuron F, Duhamel A, Didelot M, Vaast B, Rauch A, Hochart A, Bijok B, Godier A, Susen S. Glycocalyx Shedding as a Potential Driver of Trauma-induced Coagulopathy in Severe Trauma Patients: Insights from the TRAUCC Trial [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/glycocalyx-shedding-as-a-potential-driver-of-trauma-induced-coagulopathy-in-severe-trauma-patients-insights-from-the-traucc-trial/. Accessed September 29, 2023.

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