Prediction of Arterial Extravasation in Pelvic Fracture Patient with Stable Hemodynamics Using Coagulation Biomarkers: A Prospective Observational Cohort Study.

INTODUCTION: In patients who are hemodynamically stable, thrombosis indicators including fibrin degradation products (FDP), D-dimer, prothrombin time-international normalized ratio (PT-INR), along with the FDP-to-fibrinogen proportion may be capable determine artery escape as well as allow for timely treatment.

OBJECTIVES

The objective of the study was to explore the possible use of anticoagulation biomarkers as additional or additional tests for diagnosis to computed tomography (CT) by evaluating their prediction accuracy for vascular invasion among people with pelvic fractures who have stable hemodynamics.

MATERIALS AND

METHODS

Over the course of 20 months, prospective observational cohort research was carried out at the LLR Hospital, GSVM Medical College, Kanpur. We excluded individuals with instability health or significant concomitant injuries and only considered those who were adults (>18 years old) with broken pelvis with stable hemodynamics. Following CT angiography, patients were split into a couple of categories: Extravasation (Group 1, n = 24) along with non-extravasation (Group 2, n = 16). FDP, D-dimer, (PT), active partial thromboplastin time, platelet count, fibrinogen, and the FDP-to-fibrinogen ratio were all measured in blood draws obtained during admittance. To evaluate the predictive abilities of biomarkers, statistical studies were conducted using receiver operating characteristic (ROC) curves, Chi-square tests, along with t-tests.

RESULTS

The Extravasation group exhibited significantly higher FDP (14.31 µg/mL vs. 5.52 µg/mL, P < 0.001), D-dimer (789.17 ng/mL vs. 253.38 ng/mL, P < 0.001), PT (16.92 s vs. 13.27 s, P < 0.0001), INR (1.46 vs. 1.16, P = 0.012), and FDP-to-fibrinogen ratio (0.0219 vs. 0.0129, P = 0.0035) compared to the non-extravasation group. The FDP-to-fibrinogen ratio demonstrated the highest area under the ROC curve (area under the curve [AUC] = 0.92), followed by FDP (AUC = 0.85) and D-dimer (AUC = 0.83). Patients with elevated biomarkers were more likely to require angiographic embolization (P < 0.05). Injury Severity Scores were higher in the Extravasation group (mean 17.5 vs. 10.5, P < 0.05). Mortality was low (2.5%, one case in Group 1).

CONCLUSION

Coagulation biomarkers, particularly the FDP-to-fibrinogen ratio, FDP, and D-dimer, are robust predictors of arterial extravasation in hemodynamically stable pelvic fracture patients.