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Prediction of arterial extravasation in pelvic fracture patients with stable hemodynamics using coagulation biomarkers.

ABSTRACT: Background:Determining the presence of an active arterial hemorrhage in the acute phase is important as a treatment strategy in patients with pelvic fracture. The purpose of this study was to evaluate whether coagulation biomarkers could predict arterial extravasation, especially in pelvic fracture patients with stable hemodynamics. Methods:We studied patients with a pelvic fracture who had a systolic blood pressure above 90?mmHg and lactate level less than 5.0?mmol/L on hospital arrival. Patients were divided into two groups: those with arterial extravasation on enhanced computed tomography (CT) or angiography (extravasation [+] group) and those without arterial extravasation (extravasation [-] group). Coagulation biomarkers measured on arrival were statistically compared between the two groups. Predictive ability of arterial extravasation using coagulation biomarkers was evaluated by receiver-operating characteristic analyses provided area under the receiver-operating characteristic curves (AUROC) and diagnostic indicators with optimal cutoff point including sensitivity, specificity, positive and negative predictive values, and diagnostic odds ratio (DOR). Results:Sixty patients were analyzed. Fibrin degradation products (FDP), D-dimer, prothrombin time-international normalized ratio (PT-INR), and the ratio of FDP to fibrinogen were significantly higher in the extravasation (+) group than in the extravasation (-) group (FDP, 242??g/mL [145-355] vs. 96??g/mL [58-153]; D-dimer, 81??g/mL [41-140] vs. 39??g/mL [21-75]; PT-INR, 1.09 [1.05-1.24] vs. 1.02 [0.98-1.08]; and ratio of FDP to fibrinogen, 1.06 [0.85-2.01] vs. 0.46 [0.25-0.74]). The highest AUROC was with a ratio of FDP to fibrinogen of 0.777 (95% confidence interval, 0.656-0.898), and the highest predictive ability in terms of DOR was with a ratio of FDP to fibrinogen (sensitivity, 0.76; specificity, 0.76; DOR 9.90). Conclusion:Coagulation biomarker could predict of arterial extravasation in pelvic fracture patients with stable hemodynamics.

SUBMITTER: Aoki M

PROVIDER: S-EPMC6425576 | biostudies-literature | 2019

REPOSITORIES: biostudies-literature

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Prediction of arterial extravasation in pelvic fracture patients with stable hemodynamics using coagulation biomarkers.

Aoki Makoto M Ogura Takayuki T Hagiwara Shuichi S Nakamura Mitsunobu M Oshima Kiyohiro K

World journal of emergency surgery : WJES 20190319

<h4>Background</h4>Determining the presence of an active arterial hemorrhage in the acute phase is important as a treatment strategy in patients with pelvic fracture. The purpose of this study was to evaluate whether coagulation biomarkers could predict arterial extravasation, especially in pelvic fracture patients with stable hemodynamics.<h4>Methods</h4>We studied patients with a pelvic fracture who had a systolic blood pressure above 90 mmHg and lactate level less than 5.0 mmol/L on hospital ...[more]

PMID: 30930958

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Project description:Sox17 is a critical regulator of arterial identity during early embryonic vascular development. However, its role in adult endothelial cells (ECs) are not fully understood. Sox17 is highly expressed in arterial ECs but not in venous ECs throughout embryonic development to adulthood suggesting that it may play a functional role in adult arteries. Here, we investigated Sox17 mediated phenotypical changes in adult ECs. To precisely control the temporal expression level of Sox17, we designed a tetracycline-inducible lentiviral gene expression system to express Sox17 selectively in cultured venous ECs. We confirmed that Sox17-induced ECs exhibit a gene profile favoring arterial and tip cell identity. Furthermore, in comparison to control ECs, Sox17-activated ECs under shear leads to greater expression of arterial markers and suppression of venous identity. These data suggest that Sox17 enables greater hemodynamic adaptability of ECs in response to fluid shear stress. Here, we also demonstrate key morphogenic behaviors of Sox17-mediated ECs. In both vasculogenic and angiogenic 3D fibrin gel studies, Sox17-mediated ECs prefer to form cohesive vessels with one another while interfering the vessel formation of the control ECs. Sox17-mediated ECs elicit hyper-sprouting behavior in the presence of pericytes but not fibroblasts, suggesting Sox17 mediated sprouting frequency is dependent on supporting cell type. Using a microfluidic chip, we also show that Sox17-mediated ECs maintain thinner diameter vessels that do not widen under interstitial flow like the control ECs. Taken together, these data showed that Sox17 mediated EC gene expression and phenotypical changes are highly modulated in the context of biomechanical stimuli, suggesting Sox17 plays a role in regulating the arterial ECs adaptability under arterial hemodynamics as well as tip cells behavior during angiogenesis and vasculogenesis. The results from this study may be valuable in improving vein graft adaptation to arterial hemodynamics and bioengineering microvasculature for tissue engineering applications.

Dataset Information

Prediction of arterial extravasation in pelvic fracture patients with stable hemodynamics using coagulation biomarkers.

Publications

Prediction of arterial extravasation in pelvic fracture patients with stable hemodynamics using coagulation biomarkers.

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