Is it possible to improve prediction of outcome and blood requirements in the severely injured patients by defining categories of coagulopathy?

Purpose It has been suggested to define the Trauma-induced coagulopathy (TIC) with a PT ratio threshold of 1.20. We hypothesized that a more pragmatic classification would grade severity according to the PT ratio (or corresponding ROTEM clotting time: EXTEM-CT), and that this would correlate better with the need for blood products (BP) and prognosis. Methods Retrospective analysis of prospectively collected data of 1076 severely injured patients admitted from 01/2011 to 12/2019 in a university hospital. To determine the number of TIC categories and the best PT ratio or EXTEM-CT thresholds for mortality at 24-h, a modified Mazumdar approach was used. Multivariate regression analyses were done to describe the relationship between PT ratio and ROTEM parameter subclasses with mortality. Results Three thresholds were, respectively, identified for PT ratio (1.20, 1.90 and 3.00) and EXTEM-CT (90 s, 130 s, 200 s). The following categories were defined for PT ratio : ≤ 1.20 (No TIC), 1.21–1.90 (Moderate TIC), 1.91–3.00 (severe TIC), > 3.00 (major TIC); and for EXTEM-CT: < 91 s (no TIC), 91–130 s (moderate TIC), 131–200 s (severe TIC) and > 200 s (major TIC). We observed that when the PT ratio (or EXTEM-CT) increased, mortality and BP requirements increased. After multiple adjustments, we observed that each subclass of PT ratio and EXTEM-CT was independently associated with mortality at 24-h. Conclusion In this study, we have described a pragmatic classification of coagulopathy utilizing PT ratio and EXTEM-CT where increasing severity was associated with prognosis and the amount of BP administered. This could allow clinicians to better predict the outcome and anticipate the need for blood products.