Universität zu Köln

Froehlich, Matthias, Schaefer, Nadine, Caspers, Michael, Boehm, Julia K., Stuermer, Ewa K., Bouillon, Bertil and Maegele, Marc (2018). Temporal phenotyping of circulating microparticles after trauma: a prospective cohort study. Scand. J. Trauma Resusc. Emerg. Med., 26. LONDON: BIOMED CENTRAL LTD. ISSN 1757-7241

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Abstract

Background: After severe polytrauma the dynamic process of coagulation may deteriorate towards a trauma-induced coagulopathy (TIC) promoting a dramatic increase in morbidity and mortality. Recent evidence suggests that microparticles (MPs) play a pivotal role at the interface between cellular and plasmatic coagulation systems. However, the impact of MPs on functional coagulation has not been clarified yet in the setting of traumatic injuries. We assessed the temporal patterns of circulating MP concentrations including their cellular origin in the context of clinical presentation and global coagulation assays. Methods: Blood samples from 22 consecutive polytrauma patients (ISS >= 16) from 2015 were collected at hospital admission, after 24 and 72 h and compared to those from healthy individuals and minor injured patients with isolated extremity fractures. Flow cytometry (BD Accuri C6; Heidelberg/Germany) was used to determine MP concentrations and cellular origin using cell-specific markers (platelet derived (PDMP): CD42b(+), CD61(+), CD62p(+); endothelial cell derived (EDMP): CD144(+), CD62e(+), CD144(+)/62e(+)). Results were correlated with clinical data and results from viscoelastic testing (ROTEM). Results: Twenty two polytrauma patients (17 males, age(median) 60 yrs) with a median ISS 26.5 (IQR 14.5) were assessed. PDMP and EDMP concentrations increased significantly in polytrauma patients as compared to healthy individuals and minor injured patients. MP concentrations correlated with injury severity (CD144(+): rho(sp) = 0.79, p < 0.001; CD42b(+): rho(sp) = 0.61, p < 0.001). EDMP displayed a negative correlation with aPTT (CD144/62e+, rho(sp) = -0.55, p < 0.05), INR (CD144/62e(+), rho(sp) = -0.61, p < 0.05) and ROTEM-INTEM CT (CD144/62e(+), rho(sp) = -0.68, p < 0.05) reflecting increased dynamics of clot formation and an overall procoagulative effect. Additionally, EDMP showed a negative association with FIBTEM values (10 min amplitude, maximum clot firmness) indicating a fibrinolytic potential. Discussion: In a small cohort, analysing most severly injured patients, the association of increased MP levels and altered coagulation parameters could be demonstrated. However, these findings are based on correlation analysis, which do not enable causel evidence. Therefore, further in-vitro studies are needed analysing the underlying pathomechanisms. Conclusion: In conclusion, this study could demonstrate that PDMP and EDMP levels increase significantly following polytrauma correlating with injury severity. Although severe coagulopathy was not observed, EDMP levels were associated with improved coagulation parameters suggesting their essential role for regulating blood coagulation after trauma.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Froehlich, Matthias UNSPECIFIED UNSPECIFIED UNSPECIFIED Schaefer, Nadine UNSPECIFIED UNSPECIFIED UNSPECIFIED Caspers, Michael UNSPECIFIED UNSPECIFIED UNSPECIFIED Boehm, Julia K. UNSPECIFIED UNSPECIFIED UNSPECIFIED Stuermer, Ewa K. UNSPECIFIED UNSPECIFIED UNSPECIFIED Bouillon, Bertil UNSPECIFIED UNSPECIFIED UNSPECIFIED Maegele, Marc UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-189037
DOI:	10.1186/s13049-018-0499-9
Journal or Publication Title:	Scand. J. Trauma Resusc. Emerg. Med.
Volume:	26
Date:	2018
Publisher:	BIOMED CENTRAL LTD
Place of Publication:	LONDON
ISSN:	1757-7241
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language CELL-DERIVED MICROPARTICLES; ENDOTHELIAL MICROPARTICLES; THROMBIN GENERATION; PROCOAGULANT MICROPARTICLES; COAGULOPATHY; MARKER; INJURY Multiple languages Emergency Medicine Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/18903