PB1200 - Evaluation of the association of factor XIII at hospital arrival and outcomes in a cohort of severely injured patients

Tuesday, June 27, 2023

18:30 – 19:30 ET

Room: Exhibition

Presenting Author(s)

Johana C. Gomez Builes, MD, PhD(c) (she/her/hers)

Anesthesia Resident
Department of Anesthesia and Pain Medicine, University of Toronto
Toronto, Ontario, Canada

Co-Author(s)

AB

Andrew Baker

Chief, Department of Critical Care Chief, Department of Anesthesia
Department of Anesthesia and Pain Medicine, St. Michael’s Hospital, Toronto, Canada.
Toronto, Ontario, Canada
Jeannie Callum, MD

Director of Transfusion Medicine
Department of Pathology and Molecular Medicine, Kingston Health Sciences Centre, Kingston, Ontario, Canada
Kingston, Ontario, Canada
SB

Sunti Barahi

Clinical Fellow
Department of Anesthesia and Pain Medicine, University of Toronto
Toront, Ontario, Canada
JB

Johnny Bai

Anesthesia Resident
Department of Anesthesia and Pain Medicine, University of Toronto, Toronto, Canada
Toronto, Ontario, Canada
KK

Keyvan Karkouti, MD FRCPC MSc

Chief, Department of Anesthesia and Pain Management
University Health Network; Sinai Health System; Women's College Hospital
Toronto, Ontario, Canada
RN

Rosane Nisenbaum

Biostatistician
MAP Centre for Urban Health Solutions. Applied Health Research Centre.
Toronto, Ontario, Canada
Michelle Sholzberg, MDCM, FRCPC, MSc., MDCM, FRCPC, MSc

Head, Division of Hematology-Oncology
Departments of Medicine, and Laboratory Medicine and Pathobiology, Li Ka Shing Knowledge Institute, University of Toronto, Toronto, ON, Canada
Toronto, Ontario, Canada

Background: Severe traumatic bleeding depletes coagulation factor XIII (FXIII) and fibrinogen. Nearly 20% of trauma patients have reduced FXIII levels at hospital arrival, but it is unknown whether it affects bleeding-related clinical outcomes.

Aims: We aimed to evaluate the association between FXIII levels at hospital arrival and major bleeding (2 or more RBCs unit transfused and >20 g/L hemoglobin level drop in the first 24 hours). Secondarily, we determined the association between baseline FXIII levels and massive transfusion, critical administration threshold (CAT24), high transfusion requirements, and 28-day in-hospital mortality.

Methods: A retrospective cohort study was conducted in severely injured adult patients (Injury severity score, ISS, greater than 21 or more than 1unit RBC transfused in 24 hours) admitted to a level 1 trauma center. Using prospectively banked patient plasma, we measured baseline FXIII antigen levels and collected clinical and laboratory data. The association between FXIII levels and outcomes was evaluated using multivariable logistic regression models. Approval from institutional research ethics board was obtained. Instrumentation Laboratory Company provided reagents in-kind to allow for FXIII laboratory analyses.

Results: 364 trauma patients admitted during a 2-year period met inclusion criteria. Median age was 44 years (27-62 IQR) and median ISS was 29 (22-34 IQR) (Table 1). Each baseline FXIII level 0.5 U/ml decrease was associated with greater odds of major bleeding (OR 1.11, 95% CI 1.02-1.2), massive transfusion (OR 1.23, 95% CI 1.05-1.43), and high transfusion requirements (OR 1.11, 95% CI 1.02-1.22). However, there was no association between baseline FXIII levels and CAT24 (OR 1.06, 95% CI 0.96-1.17), or death (OR 1.01, 95% CI 0.92-1.1) (Figure 1).

Conclusion(s): Baseline FXIII levels in severely injured patients were inconsistently associated with bleeding-related outcomes and mortality. However, the association between baseline FXIII and massive transfusion suggests the need for further investigation of the role of FXIII in massively transfused trauma patients.