Derivation of coagulation phenotypes and the association with in-hospital mortality in traumatic brain injury

Abstract Background: The pathogenesis and pathophysiology of traumatic coagulopathy during traumatic brain injury is not well understood, and the appropriate treatment strategy for this condition has not been established. This study aimed to evaluate the coagulation phenotypes and their effect on prognosis in patients with isolated traumatic brain injury.Methods: In this multicenter cohort study, we retrospectively analyzed data from the Japan Neurotrauma Data Bank (JNTDB). Adults with isolated traumatic brain injury (head abbreviated injury scale [AIS] >2, any other AIS <3) who were registered in the JNTDB were included in this study. The primary outcome was the association of coagulation phenotypes with in-hospital mortality. Coagulation phenotypes were derived using the k-means with coagulation markers, prothrombin time international normalized ratio (PT-INR), activated partial thromboplastin time (APTT), fibrinogen (FBG), and D-dimer (DD) on arrival at the hospital. Multivariable logistic regression analyses were conducted to calculate the adjusted odds ratios (ORs) of coagulation phenotypes with their 95% confidence intervals (CIs) for in-hospital mortality.Results: In total, 556 patients were enrolled, and five coagulation phenotypes were identified. Cluster A (n=129) had the closest to normal coagulation values; cluster B (n=323) had a mild high DD phenotype; cluster C (n=30) had a prolonged PT-INR phenotype with a higher frequency of antithrombotic medication in elderly patients than in younger patients; cluster D (n=45) had a low FBG, high DD, and prolonged APTT phenotype with a high incidence of skull fracture; and cluster E (n=29) had a low FBG and extremely high DD phenotype with high-energy trauma and high incidence of skull fracture. In the multivariable logistic regression analysis, the association of clusters B, C, D, and E with in-hospital mortality yielded the corresponding adjusted ORs of 2.17 (95% CI: 1.22–3.86), 2.61 (95% CI: 1.01–6.72), 10.0 (95% CI: 4.00–25.2), and 24.1 (95% CI: 7.12–81.3), respectively, relative to cluster A.Conclusions: This multicenter observational study identified five different coagulation phenotypes of traumatic brain injury and showed associations of these phenotypes with in-hospital mortality.