@article{ref1,
title="Insights into the association between coagulopathy and inflammation: abnormal clot mechanics are a warning of immunologic dysregulation following major injury",
journal="Annals of translational medicine",
year="2020",
author="Vodovotz, Yoram and Namas, Rami A. and Zamora, Ruben and Zarzaur, Ben L. and Savage, Stephanie A. and McCarroll, Tyler and Gaski, Greg E. and McKinley, Todd O. and Billiar, Timothy R. and Callcut, Rachael A.",
volume="8",
number="23",
pages="e1576-e1576",
abstract="BACKGROUND: Severe injury initiates a complex physiologic response encompassing multiple systems and varies phenotypically between patients. Trauma-induced  coagulopathy may be an early warning of a poorly coordinated response at the  molecular level, including a deleterious immunologic response and worsening of shock  states. The onset of trauma-induced coagulopathy (TIC) may be subtle however. In  previous work, we identified an early warning sign of coagulopathy from the  admission thromboelastogram, called the MAR ratio. We hypothesized that a low MAR  ratio would be associated with specific derangements in the inflammatory response. <br><br>METHODS: In this prospective, observational study, 88 blunt trauma patients admitted  to the intensive care unit (ICU) were identified. Concentrations of inflammatory  mediators were recorded serially over the course of a week and the MAR ratio was  calculated from the admission thromboelastogram. Correlation analysis was used to  assess the relationship between MAR and inflammatory mediators. Dynamic network  analysis was used to assess coordination of immunologic response. <br><br>RESULTS:  Seventy-nine percent of patients were male and mean age was 37 years (SD 12). The  mean ISS was 30.2 (SD 12) and mortality was 7.2%. CRITICAL patients (MAR ratio  ≤14.2) had statistically higher shock volumes at three time points in the first day  compared to NORMAL patients (MAR ratio >14.2). CRITICAL patients had significant  differences in IL-6 (P=0.0065), IL-8 (P=0.0115), IL-10 (P=0.0316) and MCP-1  (P=0.0039) concentrations compared to NORMAL. Differences in degree of expression  and discoordination of immune response continued in CRITICAL patients throughout the  first day. <br><br>CONCLUSIONS: The admission MAR ratio may be the earliest warning signal  of a pathologic inflammatory response associated with hypoperfusion and TIC. A low  MAR ratio is an early indication of complicated dysfunction of multiple molecular  processes following trauma.<p /> <p>Language: en</p>",
language="en",
issn="2305-5839",
doi="10.21037/atm-20-3651",
url="http://dx.doi.org/10.21037/atm-20-3651"
}