Journal of thrombosis and haemostasis : JTH · 2025
Hyperfibrinolysis in trauma-induced coagulopathy: exploring the role of inflammatory cytokines.
СтатьяРандомизированное исследованиеНазвание и аннотация: Перевод в очереди
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Takahashi Kyosuke, Yamakawa Kazuma, Siletz Anaar E, Katsura Morihiro, Holcomb John B, Cotton Bryan A, Wade Charles E, Cardenas Jessica C, Martin Matthew, Inaba Kenji, Matsushima Kazuhide
Аннотация
BACKGROUND: Hyperfibrinolysis is the excessive fibrinolytic activity observed in severely injured patients with trauma-induced coagulopathy (TIC). Previous studies suggest that inflammatory cytokines initiate inflammatory responses triggered by trauma and could impact on the coagulation cascade; however, the association between inflammatory cytokines and the development of hyperfibrinolysis has not been fully evaluated.
OBJECTIVES: The aim of this study was to identify the characteristics of the inflammatory cytokines dynamics in TIC, particularly hyperfibrinolysis.
METHODS: This is a secondary analysis of the Pragmatic, Randomized Optimal Platelet and Plasma Ratios trial. Study patients were stratified into the hyperfibrinolysis and nonhyperfibrinolysis groups using thromboelastography LY30 values and plasmin-antiplasmin complex. Serial values of inflammatory cytokine level (0-24 hours postadmission) were compared between the hyperfibrinolysis and nonhyperfibrinolysis groups. Subgroup analysis investigated the cytokines comparing patients with traumatic brain injury with hyperfibrinolysis and those without hyperfibrinolysis.
RESULTS: A total of 477 patients were included (hyperfibrinolysis, 45; nonhyperfibrinolysis, 432). The levels of interleukin (IL)-6, interleukin 1 receptor antagonist (IL-1Ra), and major vault protein (MVP)-1 were significantly higher in the hyperfibrinolysis group than those in the nonhyperfibrinolysis group across the time points within 24 hours after presentation. The level of platelet-derived growth factor subunit B (PDGF-B) upon arrival was significantly higher in the hyperfibrinolysis group. The IL-6, IL-1Ra, and MVP-1 levels peaked at 4 hours postadmission and PDGF-B peaked upon arrival and downtrended thereafter.
CONCLUSION: The current study revealed that IL-6, IL-1Ra, and MVP-1 levels trended upward for 4 hours postadmission and PDGF-B peaked upon arrival and downtrended thereafter in severely injured patients with hyperfibrinolysis.
OBJECTIVES: The aim of this study was to identify the characteristics of the inflammatory cytokines dynamics in TIC, particularly hyperfibrinolysis.
METHODS: This is a secondary analysis of the Pragmatic, Randomized Optimal Platelet and Plasma Ratios trial. Study patients were stratified into the hyperfibrinolysis and nonhyperfibrinolysis groups using thromboelastography LY30 values and plasmin-antiplasmin complex. Serial values of inflammatory cytokine level (0-24 hours postadmission) were compared between the hyperfibrinolysis and nonhyperfibrinolysis groups. Subgroup analysis investigated the cytokines comparing patients with traumatic brain injury with hyperfibrinolysis and those without hyperfibrinolysis.
RESULTS: A total of 477 patients were included (hyperfibrinolysis, 45; nonhyperfibrinolysis, 432). The levels of interleukin (IL)-6, interleukin 1 receptor antagonist (IL-1Ra), and major vault protein (MVP)-1 were significantly higher in the hyperfibrinolysis group than those in the nonhyperfibrinolysis group across the time points within 24 hours after presentation. The level of platelet-derived growth factor subunit B (PDGF-B) upon arrival was significantly higher in the hyperfibrinolysis group. The IL-6, IL-1Ra, and MVP-1 levels peaked at 4 hours postadmission and PDGF-B peaked upon arrival and downtrended thereafter.
CONCLUSION: The current study revealed that IL-6, IL-1Ra, and MVP-1 levels trended upward for 4 hours postadmission and PDGF-B peaked upon arrival and downtrended thereafter in severely injured patients with hyperfibrinolysis.