Hunter B Moore1, Matthew D Neal2, Marnie Bertolet3, Brian A Joughin4,5,6, Michael B Yaffe4,5,6,7, Christopher D Barrett4,5,7, Molly A Bird4,5,6, Russell P Tracy8, Ernest E Moore1,9, Jason L Sperry2, Brian S Zuckerbraun2, Myung S Park10, Mitchell J Cohen1, Stephen R Wisniewski3, James H Morrissey11. 1. University of Colorado, Department of Surgery. 2. University of Pittsburgh, Pittsburgh Trauma Research Center, Department of Surgery. 3. University of Pittsburgh, Department of Epidemiology. 4. Massachusetts Institute of Technology, Department of Biological Engineering. 5. Koch Institute for Integrative Cancer Research at MIT. 6. Center for Precision Cancer Medicine. 7. Beth Israel Deaconess Medical Center, Harvard Medical School, Department of Surgery. 8. University of Vermont Department of Biochemistry. 9. Ernest E Moore Shock Trauma Center at Denver Health, Department of Surgery. 10. Mayo Clinic Rochester, Department of Surgery. 11. University of Michigan Medical School, Departments of Biological Chemistry and Internal Medicine.
Abstract
Objective: Trauma-induced coagulopathy (TIC) is provoked by multiple mechanisms and is perceived to be one driver of massive transfusions (MT). Single laboratory values using prothrombin time (INR) or thrombelastography (TEG) are used to clinically define this complex process. We used a proteomics approach to test whether current definitions of TIC (INR, TEG, or clinical judgement) are sufficient to capture the majority of protein changes associated with MT. Methods: Eight level-I trauma centers contributed blood samples from patients available early after injury. TIC was defined as INR >1.5 (INR-TIC), TEG maximum amplitude <50mm (TEG-TIC), or clinical judgement (Clin-TIC) by the trauma surgeon. MT was defined as > 10 units of red blood cells in 24 hours or > 4 units RBC/hour during the first 4 hr. SomaLogic proteomic analysis of 1,305 proteins was performed. Pathways associated with proteins dysregulated in patients with each TIC definition and MT were identified. Results: Patients (n=211) had a mean injury severity score of 24, with a MT and mortality rate of 22% and 12%, respectively. We identified 578 SOMAscan analytes dysregulated among MT patients, of which INR-TIC, TEG-TIC, and Clin-TIC patients showed dysregulation only in 25%, 3%, and 4% of these, respectively. TIC definitions jointly failed to show changes in 73% of the protein levels associated with MT, and failed to identify 26% of patients that received a massive transfusion. INR-TIC and TEG-TIC patients showed dysregulation of proteins significantly associated with complement activity. Proteins dysregulated in Clin-TIC or massive transfusion patients were not significantly associated with any pathway. Conclusion: These data indicate there are unexplored opportunities to identify patients at risk for massive bleeding. Only a small subset of proteins that are dysregulated in patients receiving MT are statistically significantly dysregulated among patients whose TIC is defined based solely on laboratory measurements or clinical assessment.
Objective: Trauma-induced coagulopathy (TIC) is provoked by multiple mechanisms and is perceived to be one driver of massive transfusions (MT). Single laboratory values using prothrombin time (INR) or thrombelastography (TEG) are used to clinically define this complex process. We used a proteomics approach to test whether current definitions of TIC (INR, TEG, or clinical judgement) are sufficient to capture the majority of protein changes associated with MT. Methods: Eight level-I trauma centers contributed blood samples from patients available early after injury. TIC was defined as INR >1.5 (INR-TIC), TEG maximum amplitude <50mm (TEG-TIC), or clinical judgement (Clin-TIC) by the trauma surgeon. MT was defined as > 10 units of red blood cells in 24 hours or > 4 units RBC/hour during the first 4 hr. SomaLogic proteomic analysis of 1,305 proteins was performed. Pathways associated with proteins dysregulated in patients with each TIC definition and MT were identified. Results: Patients (n=211) had a mean injury severity score of 24, with a MT and mortality rate of 22% and 12%, respectively. We identified 578 SOMAscan analytes dysregulated among MT patients, of which INR-TIC, TEG-TIC, and Clin-TIC patients showed dysregulation only in 25%, 3%, and 4% of these, respectively. TIC definitions jointly failed to show changes in 73% of the protein levels associated with MT, and failed to identify 26% of patients that received a massive transfusion. INR-TIC and TEG-TIC patients showed dysregulation of proteins significantly associated with complement activity. Proteins dysregulated in Clin-TIC or massive transfusion patients were not significantly associated with any pathway. Conclusion: These data indicate there are unexplored opportunities to identify patients at risk for massive bleeding. Only a small subset of proteins that are dysregulated in patients receiving MT are statistically significantly dysregulated among patients whose TIC is defined based solely on laboratory measurements or clinical assessment.
Authors: C D Barrett; A T Hsu; C D Ellson; B Y Miyazawa; Y-W Kong; J D Greenwood; S Dhara; M D Neal; J L Sperry; M S Park; M J Cohen; B S Zuckerbraun; M B Yaffe Journal: Clin Exp Immunol Date: 2018-09-09 Impact factor: 4.330
Authors: Hunter B Moore; Ernest E Moore; Michael P Chapman; Kevin McVaney; Gary Bryskiewicz; Robert Blechar; Theresa Chin; Clay Cothren Burlew; Fredric Pieracci; F Bernadette West; Courtney D Fleming; Arsen Ghasabyan; James Chandler; Christopher C Silliman; Anirban Banerjee; Angela Sauaia Journal: Lancet Date: 2018-07-20 Impact factor: 79.321
Authors: Joshua B Brown; Matthew D Neal; Francis X Guyette; Andrew B Peitzman; Timothy R Billiar; Brian S Zuckerbraun; Jason L Sperry Journal: Prehosp Emerg Care Date: 2014-07-30 Impact factor: 3.077
Authors: Kristin B Nystrup; Nis A Windeløv; Annemarie B Thomsen; Pär I Johansson Journal: Scand J Trauma Resusc Emerg Med Date: 2011-09-28 Impact factor: 2.953
Authors: I Raza; R Davenport; C Rourke; S Platton; J Manson; C Spoors; S Khan; H D De'Ath; S Allard; D P Hart; K J Pasi; B J Hunt; S Stanworth; P K MacCallum; K Brohi Journal: J Thromb Haemost Date: 2013-02 Impact factor: 5.824