Key laboratory changes in severe trauma, a different pattern for each clinical phenotype.

Abstract

Objective: to compare the different evolution of conventional laboratory parameters between three severe trauma phenotypes.

Design: Observational study of a prospectively collected cohort of severe trauma patients, with retrospective database completion, studied between 2012 and 2022.

Setting: A trauma intensive care unit (ICU).

Patients: Severe trauma patients were defined by an Abbreviated Injury Scale of ≥ 3 in at least one aspect. Three groups were stablished according to hemodynamic status and Glasgow coma scale (GCS), and they were subsequently subdivided in prematurely deceased and survivors after > 72 h (h). Laboratory parameters were followed up to 96 h, statistical analysis between groups and subgroups was performed at 0 and 24 h.

Interventions: None.

Main variables of interest: Prehospital, clinical variables on admission, prognostic variables (prospective gathering); blood count, biochemistry, coagulation, blood gas analysis (retrospectively collected).

Results: 1631 patients were included, 8% prematurely deceased. Initial leukocytosis and hyperglycemia were common in all groups. Hemodynamically stable patients with a GCS < 14 stood out due to a high neutrophil-to-lymphocyte ratio (NLR) and hypernatremia, both of them at 24 h, together with initial coagulopathy in the prematurely deceased. Hemodynamically unstable patients exhibited an initial pattern of lactic acidosis, coagulopathy, and decreased platelet-to-lymphocyte ratio, hemoglobin, albumin and calcium, all these changes being most prominent in the prematurely deceased. A 24 h peak in NLR was found in both the hemodynamically unstable and GCS < 14 groups.

Conclusion: Evolution of laboratory parameters differ according to the patient's phenotype. They complete the initial severity evaluation and in hemodynamically stable patients they act as a warning for potential neurological damage.