Otto Thielen (Aurora, CO / US), Christopher Erickson (Aurora, CO / US), Terry J Schaid (Aurora, CO / US), William Hallas (Aurora, CO / US), Alexis Cralley (Aurora, CO / US), Sanchayita Mitra (Aurora, CO / US), Preston Stafford (Aurora, CO / US), Christopher Silliman (Aurora, CO / US), Angelo D'Alessandro (Aurora, CO / US), Kirk Hansen (Aurora, CO / US), Ernest E. Moore (Aurora, CO / US), Mitchell J Cohen (Aurora, CO / US)
Abstract text (incl. references and figure legends)
Introduction: The lethal triad of trauma from uncontrolled hemorrhage is well recognized after severe injury. Clinically, however, base deficit (BD) and lactate have been used instead of pH as predictors of outcome and to guide resuscitation. PH has been overlooked because of its logarithmic range and respiratory compensation, thought to limit its clinical usefulness. Thus, current therapy is aimed at stopping blood loss and resuscitating to BD and lactate clearance. Small changes in pH have significant biochemical effects on coagulation yet little is known about the effect of clinical pH measures on trauma-induced coagulopathy (TIC). We hypothesized that small changes in pH even within the "normal" physiologic range have biochemical outcomes that affect normal coagulation.
Methods: Serum samples from 709 injured patients were collected upon arrival to an urban Level 1 Trauma Center. Linear regression models were used to establish the relationship between pH on coagulation values, controlling for BD and injury severity score (ISS).
Results: Blunt injury was the predominant mechanism (57.12 %). The median age of patients was 35.7, mortality 10.3 %, ISS 17, pH 7.33, and BD -6. There is an inverse relationship between pH and international normalized ratio (INR), partial thromboplastin time (PTT), and clot lysis at 30 minutes (LY30) even when controlling for BD (p< .05). There was no statistically significant association between BE and coagulation parameters in a model that includes changes in ph.
Conclusions: There is an independent, inverse relationship between pH and INR, PTT, and LY30. This suggests pH has an underappreciated effect on coagulation biochemistry and may be a superior resuscitation endpoint for managing TIC. Further understanding of the impact that small changes in pH have on the biochemistry of the injured patient is essential to understanding and treating TIC.
References: Moore et al. Trauma-induced coagulopathy doi:10.1038/s41572-021-00264-3.
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