Background: Coagulopathy often develops in patients with serious trauma and is correlated with the clinical\r\noutcome. The contribution of platelet activity and endothelial dysfunction to trauma-induced coagulopathy remain\r\nto be defined. The purpose of this study was to investigate the time courses of soluble P-selectin (sPsel, an index of\r\nplatelet activation) and von Willebrand factor (VWF, an index of endothelial dysfunction) in trauma patients and\r\nelucidate their relationship to coagulation parameter levels, the presence of coagulopathy, and patient outcome.\r\nMethods: This prospective observational study, which took place in a university hospital intensive care unit (ICU),\r\nincluded 82 severely injured trauma patients. The sPsel, VWF antigen, protein C, and factor VII levels were measured\r\nand routine coagulation tests were performed upon admission to ICU and daily within the first week. The 30-day\r\nmortality rate was also determined.\r\nResults: Thirty-seven (45.1%) patients developed coagulopathy upon admission to the ICU, and the 30-day\r\nmortality rate was 20.7% (n = 17). Both the admission sPsel and VWF levels were lower in patients with\r\ncoagulopathy than in those without (p < 0.05) and were significantly correlated with the protein C and factor VII\r\nlevels, respectively (all p < 0.05). The VWF levels were lower during the first 3 days and higher on day 7 after\r\nadmission in nonsurvivors than in survivors (all p < 0.05). No significant differences in sPsel levels were found\r\nbetween nonsurvivors and survivors on each day during the first week.\r\nConclusion: In severely injured trauma patients in the ICU, lower levels of sPsel and VWF on admission were\r\nassociated with the presence of coagulopathy and might not predict a better outcome. An increase in the VWF\r\nlevel at the end of the first week after admission to ICU was associated with increased 30-day mortality.
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