Impact of antithrombin III deficiency on clinical outcomes in trauma patients: a systematic review and meta-analysis.

BACKGROUND: Antithrombin III (ATIII) is a key regulator of coagulation, playing a vital role in maintaining hemostatic balance. Reduced ATIII levels have been observed in trauma patients, potentially contributing to an increased risk of mortality, thromboembolic events, and coagulopathy. While ATIII deficiency has been associated with worse clinical outcomes in critically ill patients, less is known about its impact on trauma patient populations. PURPOSE: This meta-analysis aims to evaluate the association between ATIII deficiency and clinical outcomes, including mortality, thromboembolism, disseminated intravascular coagulation (DIC), and shock in trauma patients. METHODS: PubMed, Embase, and the Cochrane Library databases were searched for randomized trials and observational studies that compared trauma patients with ATIII deficiency with those with normal ATIII levels and reported outcomes related to mortality, thromboembolic events, DIC, and shock. Heterogeneity was assessed using the I² statistic. A random-effects model was applied to all outcomes to account for potential variations across studies. RESULTS: We included nine observational studies with a total of 1,629 trauma patients, all of which contributed data to at least one analyzed outcome. Compared with trauma patients with normal ATIII levels, those with ATIII deficiency had an association with a higher risk of mortality (pooled OR 3.61; 95% CI 2.36–5.50; p < 0.01), thromboembolic events (pooled OR 2.14; 95% CI 1.21–3.80; p = 0.009), and shock (pooled OR 4.65; 95% CI 3.16–6.83; p < 0.01). However, no difference was found for DIC between groups (pooled OR 6.63; 95% CI 0.89–49.44; p = 0.06). CONCLUSION: These findings suggest that ATIII deficiency is associated with worse clinical outcomes in trauma patient populations. Further research is needed to determine whether targeted ATIII management strategies could improve outcomes in trauma patients.