International Normalized Ratio As a Predictor of Mortality in Trauma Patients in India

Overview

Journal World J Emerg Med

Specialty Emergency Medicine

Date 2014 Sep 17

PMID 25225583

Citations 8

Authors

Ankur Verma

Tamorish Kole

Affiliations

Soon will be listed here.

Abstract

Background: Hemorrhage is the second leading cause of death in trauma patients preceded only by traumatic brain injury. But hemorrhagic shock is the most common cause of preventable death within 6 hours of admission. Traumatic coagulopathy is a hypocoagulable state that occurs in the most severely injured. International normalized ratio (INR) and its relationship with trauma mortality have not been studied specifically. This study aimed to establish a predictive value of INR for trauma-related mortality.

Methods: A total of 99 trauma patients aged 18-70 years were included in the study. Their INR was determined and patient progression was followed up till death/discharge. According to previous retrospective studies, the cutoff value for INR in our study was kept at 1.5.

Results: The total mortality rate of the patients was 16.16% (16/99). The mean INR was 1.45 with a SD of 1.35. INR was deranged in a total of 14 patients (14.14%). Of these patients, 11 died (78.57%) and 3 survived. INR was deranged in 11 (68.75%) of the 16 patients who died, but 5 deaths (31.25%) had normal INR values. The sensitivity of INR was 69% (95%CI 41%-88%) and the specificity 96% (95%CI 90%-99%). The diagnostic accuracy of INR was 92% (95%CI 85%-96%). Positive predictive value and negative predictive value were 79% (95%CI 49%-95%) and 94% (95%CI 87%-98%), respectively.

Conclusion: Our results showed that INR is a good predictor of mortality in trauma patients.

Citing Articles

Conventional Coagulation Tests are a better predictor of mortality than Viscoelastic Haemostatic Assays in trauma patients with shock: a prospective observational study.

Jonish A, James J, Titus D, Sharma S, Purushothaman V, Dave R Eur J Trauma Emerg Surg. 2025; 51(1):131.

PMID: 40074918 DOI: 10.1007/s00068-025-02808-8.

The prognostic value of an age-adjusted BIG score in adult patients with traumatic brain injury.

Bai X, Wang R, Zhang C, Wen D, Ma L, He M Front Neurol. 2023; 14:1272994.

PMID: 38020644 PMC: 10656741. DOI: 10.3389/fneur.2023.1272994.

Effect of INR on Outcomes of Endovascular Treatment for Acute Vertebrobasilar Artery Occlusion.

Xu Y, Huang Z, Zhang P, Zhong J, Zhang W, Hu M Transl Stroke Res. 2023; 15(5):916-924.

PMID: 37442918 DOI: 10.1007/s12975-023-01176-y.

Diagnostic and Prognostic Significance of the Prothrombin Time/International Normalized Ratio in Sepsis and Septic Shock.

Schupp T, Weidner K, Rusnak J, Jawhar S, Forner J, Dulatahu F Clin Appl Thromb Hemost. 2022; 28:10760296221137893.

PMID: 36503298 PMC: 9749050. DOI: 10.1177/10760296221137893.

Independent Predictors of Mortality in Torso Trauma Injuries.

Bini R, Accardo C, Granieri S, Sammartano F, Cimbanassi S, Renzi F J Clin Med. 2020; 9(10).

PMID: 33023012 PMC: 7600101. DOI: 10.3390/jcm9103202.

References

Sauaia A, Moore F, Moore E, Moser K, Brennan R, Read R . Epidemiology of trauma deaths: a reassessment. J Trauma. 1995; 38(2):185-93. DOI: 10.1097/00005373-199502000-00006. View

Brohi K . Trauma induced coagulopathy. J R Army Med Corps. 2010; 155(4):320-2. DOI: 10.1136/jramc-155-04-15. View

MacLeod J, Lynn M, McKenney M, Cohn S, Murtha M . Early coagulopathy predicts mortality in trauma. J Trauma. 2003; 55(1):39-44. DOI: 10.1097/01.TA.0000075338.21177.EF. View

Holcomb J, McMullin N, Pearse L, Caruso J, Wade C, Oetjen-Gerdes L . Causes of death in U.S. Special Operations Forces in the global war on terrorism: 2001-2004. Ann Surg. 2007; 245(6):986-91. PMC: 1876965. DOI: 10.1097/01.sla.0000259433.03754.98. View

Siegel J . The effect of associated injuries, blood loss, and oxygen debt on death and disability in blunt traumatic brain injury: the need for early physiologic predictors of severity. J Neurotrauma. 1995; 12(4):579-90. DOI: 10.1089/neu.1995.12.579. View

Roberts I, Shakur H, Ker K, Coats T . Antifibrinolytic drugs for acute traumatic injury. Cochrane Database Syst Rev. 2011; (1):CD004896. DOI: 10.1002/14651858.CD004896.pub3. View

Maegele M, Paffrath T, Bouillon B . Acute traumatic coagulopathy in severe injury: incidence, risk stratification, and treatment options. Dtsch Arztebl Int. 2012; 108(49):827-35. PMC: 3254043. DOI: 10.3238/arztebl.2011.0827. View

Xu J, Kochanek K, Murphy S, Tejada-Vera B . Deaths: final data for 2007. Natl Vital Stat Rep. 2014; 58(19):1-19. View

Innes D, SEVITT S . COAGULATION AND FIBRINOLYSIS IN INJURED PATIENTS. J Clin Pathol. 1964; 17:1-13. PMC: 480663. DOI: 10.1136/jcp.17.1.1. View

10.

Brohi K, Cohen M, Ganter M, Schultz M, Levi M, Mackersie R . Acute coagulopathy of trauma: hypoperfusion induces systemic anticoagulation and hyperfibrinolysis. J Trauma. 2008; 64(5):1211-7. DOI: 10.1097/TA.0b013e318169cd3c. View

11.

Brohi K, Singh J, Heron M, Coats T . Acute traumatic coagulopathy. J Trauma. 2003; 54(6):1127-30. DOI: 10.1097/01.TA.0000069184.82147.06. View

12.

Esposito T, Sanddal N, Hansen J, Reynolds S . Analysis of preventable trauma deaths and inappropriate trauma care in a rural state. J Trauma. 1995; 39(5):955-62. DOI: 10.1097/00005373-199511000-00022. View

13.

Spinella P, Holcomb J . Resuscitation and transfusion principles for traumatic hemorrhagic shock. Blood Rev. 2009; 23(6):231-40. PMC: 3159517. DOI: 10.1016/j.blre.2009.07.003. View

14.

Tien H, Spencer F, Tremblay L, Rizoli S, Brenneman F . Preventable deaths from hemorrhage at a level I Canadian trauma center. J Trauma. 2007; 62(1):142-6. DOI: 10.1097/01.ta.0000251558.38388.47. View

15.

Hess J, Lindell A, Stansbury L, Dutton R, Scalea T . The prevalence of abnormal results of conventional coagulation tests on admission to a trauma center. Transfusion. 2008; 49(1):34-9. DOI: 10.1111/j.1537-2995.2008.01944.x. View

16.

Malone D, Hess J, Fingerhut A . Massive transfusion practices around the globe and a suggestion for a common massive transfusion protocol. J Trauma. 2006; 60(6 Suppl):S91-6. DOI: 10.1097/01.ta.0000199549.80731.e6. View

17.

Ragaller M . What's new in Emergencies, Trauma and Shock? Coagulation is in the focus!. J Emerg Trauma Shock. 2010; 3(1):1-3. PMC: 2823136. DOI: 10.4103/0974-2700.58649. View