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 December 3, 2021.« Back to ISTH 2020 Congress
ISTH Congress Abstracts - https://abstracts.isth.org/abstract/glycocalyx-shedding-as-a-potential-driver-of-trauma-induced-coagulopathy-in-severe-trauma-patients-insights-from-the-traucc-trial/