BACKGROUND: Traumatic injury is associated with an increased risk of coagulopathy and venous thrombosis. plasminogen activator inhibitor-1 (PAI-1) is a procoagulant molecule that inhibits tPA/uPA, thrombomodulin, and activated protein C. We hypothesized that elevated PAI-1 levels would be associated with increased Injury Severity Score (ISS) in injured patients with and without traumatic brain injury and that PAI-1 levels would vary with injury type. METHODS: We retrospectively analyzed demographic, ISS, and hemodynamic data from a prospectively collected database. Patients with traumatic injury requiring intensive care unit admission (n = 268) were classified as multiple injuries, isolated body, or isolated head based on Abbreviated Injury Severity score. Admission PAI-1 levels were quantified using a Luminex analyte platform. Univariate tests for association informed the construction of a multivariate model of the relationship between PAI-1 and ISS. RESULTS: Plasminogen activator inhibitor-1 positively associated with ISS (p < 0.0001) and was highest in patients with ISS greater than 35 (p < 0.0001). Plasminogen activator inhibitor-1 was significantly different between multiple injuries, isolated body, and isolated head patients (p < 0.0001). On univariate analysis, age (p = 0.0011), hypotension (p = 0.0076), and alcohol intoxication (p = 0.0024) were all positively associated with PAI-1 level. Admission international normalized ratio was not associated with PAI-1 level (p = 0.638). After adjusting for age, sex, hypotension, and alcohol intoxication, higher PAI-1 levels were associated with higher ISS (p < 0.0001). CONCLUSION: Elevated PAI-1 at admission is associated with higher ISS. This association is more pronounced in patients with hypotension. These findings suggest that PAI-1 levels may reflect the burden of endothelial damage and platelet activation after injury. LEVEL OF EVIDENCE: Prognostic, level III.
BACKGROUND:Traumatic injury is associated with an increased risk of coagulopathy and venous thrombosis. plasminogen activator inhibitor-1 (PAI-1) is a procoagulant molecule that inhibits tPA/uPA, thrombomodulin, and activated protein C. We hypothesized that elevated PAI-1 levels would be associated with increased InjurySeverity Score (ISS) in injured patients with and without traumatic brain injury and that PAI-1 levels would vary with injury type. METHODS: We retrospectively analyzed demographic, ISS, and hemodynamic data from a prospectively collected database. Patients with traumatic injury requiring intensive care unit admission (n = 268) were classified as multiple injuries, isolated body, or isolated head based on Abbreviated InjurySeverity score. Admission PAI-1 levels were quantified using a Luminex analyte platform. Univariate tests for association informed the construction of a multivariate model of the relationship between PAI-1 and ISS. RESULTS:Plasminogen activator inhibitor-1 positively associated with ISS (p < 0.0001) and was highest in patients with ISS greater than 35 (p < 0.0001). Plasminogen activator inhibitor-1 was significantly different between multiple injuries, isolated body, and isolated head patients (p < 0.0001). On univariate analysis, age (p = 0.0011), hypotension (p = 0.0076), and alcohol intoxication (p = 0.0024) were all positively associated with PAI-1 level. Admission international normalized ratio was not associated with PAI-1 level (p = 0.638). After adjusting for age, sex, hypotension, and alcohol intoxication, higher PAI-1 levels were associated with higher ISS (p < 0.0001). CONCLUSION: Elevated PAI-1 at admission is associated with higher ISS. This association is more pronounced in patients with hypotension. These findings suggest that PAI-1 levels may reflect the burden of endothelial damage and platelet activation after injury. LEVEL OF EVIDENCE: Prognostic, level III.
Authors: Sean P McCully; Loic J Fabricant; Nicholas R Kunio; Tahnee L Groat; Katherine M Watson; Jerome A Differding; Thomas G Deloughery; Martin A Schreiber Journal: J Trauma Acute Care Surg Date: 2013-12 Impact factor: 3.313
Authors: I Mertens; A Verrijken; J J Michiels; M Van der Planken; J B Ruige; L F Van Gaal Journal: Int J Obes (Lond) Date: 2006-01-03 Impact factor: 5.095
Authors: Mitchell Jay Cohen; Karim Brohi; Michael T Ganter; Geoffrey T Manley; Robert C Mackersie; Jean-François Pittet Journal: J Trauma Date: 2007-12
Authors: Gustav Folmer Genét; Pär Ingemar Johansson; Martin Abild Stengaard Meyer; Sacha Sølbeck; Anne Marie Sørensen; Claus Falck Larsen; Karen Lise Welling; Nis Agerlin Windeløv; Lars S Rasmussen; Sisse Rye Ostrowski Journal: J Neurotrauma Date: 2013-02-05 Impact factor: 5.269
Authors: Michael P Chapman; Ernest E Moore; Hunter B Moore; Eduardo Gonzalez; Fabia Gamboni; James G Chandler; Sanchayita Mitra; Arsen Ghasabyan; Theresa L Chin; Angela Sauaia; Anirban Banerjee; Christopher C Silliman Journal: J Trauma Acute Care Surg Date: 2016-01 Impact factor: 3.313