Coagulopathy on the first postoperative day predicting the long-term survival of traumatic brain injury patients

Objective: The purpose of this study was to identify the relationship between coagulopathy during the perioperative period (before the operation and on the first day after the operation) and the long-term survival of TBI patients undergoing surgery, as well as to explore the predisposing risk factors that may cause perioperative coagulopathy.Methods: This retrospective study included 447 TBI patients who underwent surgery from January 1, 2015 to April 25, 2019. Clinical parameters, including patient demographic characteristics, biochemical tests, perioperative coagulation function tests (before the operation and on the first day after the operation) and intraoperative factors were collected. Log-rank univariate analysis and Cox regression models were conducted to assess the relationship between perioperative coagulopathy and the long-term survival of TBI patients. Furthermore, univariate and multivariate analyses were performed to identify the underlying risk factors for perioperative coagulopathy.Results: Multivariate Cox regression analysis identified age, AIS(head) = 5, GCS ≤ 8, systolic pressure at admission < 90 mmHg and postoperative coagulopathy (all P < 0.05) as independent risk factors for survival following TBI; we were the first to identify postoperative coagulopathy as an independent risk factor. According to multivariate logistic regression analysis, for the first time, abnormal ALT and RBC at admission, preoperative coagulopathy, infusion of colloidal solution > 1100 mL and intraoperative bleeding > 950 mL (all P < 0.005) were identified as independent risk factors for postoperative coagulation following surgery after TBI.Conclusions: Those who suffered from postoperative coagulopathy due to TBI had a higher hazard for poor prognosis than those who did not. Closer attention should be paid to postoperative coagulopathy and more emphasis should be placed on managing the underlying risk factors.