Longitudinal D-Dimer Trajectories and the Risk of Mortality in Abdominal Trauma Patients: A Group-Based Trajectory Modeling Analysis

This study aimed to identify the long-term D-dimer trajectory patterns and their associations with in-hospital all-cause mortality in abdominal trauma patients. This is a retrospective cohort study of general adult abdominal trauma patients admitted to Jinling Hospital (Nanjing, China) between January 2010 and April 2020. Group-based trajectory modeling was applied to model D-dimer trajectories over the first 50 days post-trauma. A multivariable logistic regression was performed to estimate the associations between D-dimer trajectories and in-hospital all-cause mortality. A total of 309 patients were included. We identified four distinct D-dimer trajectories: group 1 (57.61%; “stable low”), group 2 (28.16%; “moderate-decline”), group 3 (8.41%; “high-rapid decline”), and group 4 (5.83%; “high-gradual decline”). The SOFA score (p = 0.005) and ISS (p = 0.001) were statistically higher in groups 3 and 4 than in groups 1 and 2. The LMWH and UFH did not differ between groups 3 and 4. Compared with the patients in group 1, only the patients in group 4 were at a higher risk of in-hospital all-cause mortality (OR = 6.94, 95% CI: 1.20–40.25). The long-term D-dimer trajectories post-trauma were heterogeneous and associated with mortality. An initially high and slowly-resolved D-dimer might function as the marker of disease deterioration, and specific interventions are needed.

[1]  A. Avogaro,et al.  Time-series analysis of multidimensional clinical-laboratory data by dynamic Bayesian networks reveals trajectories of COVID-19 outcomes , 2022, Computer Methods and Programs in Biomedicine.

[2]  Eric J. Ley,et al.  American Association for the Surgery of Trauma/American College of Surgeons-Committee on Trauma Clinical Protocol for inpatient venous thromboembolism prophylaxis after trauma , 2021, The journal of trauma and acute care surgery.

[3]  A. Oldner,et al.  Temporal patterns of organ dysfunction after severe trauma , 2021, Critical Care.

[4]  Linda R. Petzold,et al.  Associations of longitudinal D-Dimer and Factor II on early trauma survival risk , 2021, BMC Bioinform..

[5]  R. Payton.  The Facts , 1984, The Divide.

[6]  M. Choinière,et al.  Trajectory Modelling Techniques Useful to Epidemiological Research: A Comparative Narrative Review of Approaches , 2020, Clinical epidemiology.

[7]  Eun Sug Park,et al.  Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019 , 2020, Lancet.

[8]  J. Weitz.  Faculty Opinions recommendation of American Society of Hematology 2018 guidelines for management of venous thromboembolism: diagnosis of venous thromboembolism. , 2020, Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature.

[9]  J. Mascarenhas,et al.  Admission D-dimer levels, D-dimer trends, and outcomes in COVID-19 , 2020, Thrombosis Research.

[10]  Eric J. Ley,et al.  Updated guidelines to reduce venous thromboembolism in trauma patients: A Western Trauma Association critical decisions algorithm , 2020, The journal of trauma and acute care surgery.

[11]  N. Tang,et al.  Characteristics of emergency patients with markedly elevated D-dimer levels , 2020, Scientific Reports.

[12]  R. Loos,et al.  Identifying typical trajectories in longitudinal data: modelling strategies and interpretations , 2020, European Journal of Epidemiology.

[13]  Michael D Healy,et al.  Multiple organ dysfunction after trauma , 2019, The British journal of surgery.

[14]  L. Boyer,et al.  Epidemiology of trauma in France: mortality and risk factors based on a national medico-administrative database. , 2019, Anaesthesia, critical care & pain medicine.

[15]  Thomas W. White,et al.  It's sooner than you think: Blunt solid organ injury patients are already hypercoagulable upon hospital admission - Results of a bi-institutional, prospective study. , 2019, American journal of surgery.

[16]  P. Schuetz,et al.  Diagnostic and prognostic value of the D-dimer test in emergency department patients: secondary analysis of an observational study , 2019, Clinical chemistry and laboratory medicine.

[17]  J. Vincent,et al.  The European guideline on management of major bleeding and coagulopathy following trauma: fifth edition , 2019, Critical Care.

[18]  T. Matsuoka,et al.  Impact of initial coagulation and fibrinolytic markers on mortality in patients with severe blunt trauma: a multicentre retrospective observational study , 2019, Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine.

[19]  H. Schünemann,et al.  American Society of Hematology 2018 guidelines for management of venous thromboembolism: diagnosis of venous thromboembolism. , 2018, Blood advances.

[20]  B. Lee,et al.  High fibrin/fibrinogen degradation product to fibrinogen ratio is associated with 28-day mortality and massive transfusion in severe trauma , 2018, European Journal of Trauma and Emergency Surgery.

[21]  J. Eikelboom,et al.  A Test in Context: D-Dimer. , 2017, Journal of the American College of Cardiology.

[22]  A. Nakao,et al.  Venous thromboembolism in major trauma patients: a single‐center retrospective cohort study of the epidemiology and utility of D‐dimer for screening , 2017, Acute medicine & surgery.

[23]  H. Yokota,et al.  Time Course of Coagulation and Fibrinolytic Parameters in Patients with Traumatic Brain Injury. , 2016, Journal of neurotrauma.

[24]  S. Kushimoto,et al.  High D-Dimer Levels Predict a Poor Outcome in Patients with Severe Trauma, Even with High Fibrinogen Levels on Arrival: A Multicenter Retrospective Study , 2016, Shock.

[25]  R. Bellomo,et al.  The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). , 2016, JAMA.

[26]  A. Sauaia,et al.  Hyperfibrinolysis, physiologic fibrinolysis, and fibrinolysis shutdown: The spectrum of postinjury fibrinolysis and relevance to antifibrinolytic therapy , 2014, The journal of trauma and acute care surgery.

[27]  D. Nagin.  Group-Based Trajectory Modeling: An Overview , 2014, Annals of Nutrition and Metabolism.

[28]  C. Boselli,et al.  The surface landmarks of the abdominal wall: a plea for standardization , 2014, Archives of medical science : AMS.

[29]  Y. Ohyama,et al.  Usefulness of fibrin degradation products and d‐dimer levels as biomarkers that reflect the severity of trauma , 2013, The journal of trauma and acute care surgery.

[30]  J. Kellum,et al.  Diagnosis, evaluation, and management of acute kidney injury: a KDIGO summary (Part 1) , 2013, Critical Care.

[31]  Jun Ding,et al.  Predicting outcomes after traumatic brain injury: The development and validation of prognostic models based on admission characteristics , 2012, The journal of trauma and acute care surgery.

[32]  Daniel S Nagin,et al.  Group-based trajectory modeling in clinical research. , 2010, Annual review of clinical psychology.

[33]  E. P. Dellinger,et al.  Diagnosis and management of complicated intra-abdominal infection in adults and children: guidelines by the Surgical Infection Society and the Infectious Diseases Society of America. , 2010, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[34]  S. Gando.  Tissue factor in trauma and organ dysfunction. , 2006, Seminars in thrombosis and hemostasis.

[35]  C. Anderson‐Cook,et al.  Group-Based Modeling of Development , 2006 .

[36]  Nicole A. Lazar,et al.  Statistical Analysis With Missing Data , 2003, Technometrics.

[37]  A. Peitzman,et al.  Hepatic dysfunction increases length of stay and risk of death after injury. , 2002, The Journal of trauma.

[38]  A. Smally.  D-dimer assay. , 1998, Annals of emergency medicine.

[39]  W. Copes,et al.  Evaluating trauma care: the TRISS method. Trauma Score and the Injury Severity Score. , 1987, The Journal of trauma.