Correlation between factor (F)XIa, FIXa and tissue factor and trauma severity.

BACKGROUND: It has been observed that trauma patients often display elevated procoagulant activity that could be caused, in part, by tissue factor (TF). We previously observed that trauma patients with thermal, blunt and penetrating injuries have active FIXa and FXIa in their plasma. In the current study we evaluated the effect of injury severity, with or without accompanying shock, on the frequency and concentration of TF, FIXa and FXIa in plasma from trauma patients. METHODS: Eighty trauma patients were enrolled and divided equally into 4 groups based on their injury severity score (ISS) and base deficit (BD): Group 1: Non-severe injury, no shock Group 2: Non-severe injury, with shock Group 3: Severe injury, no shock Group 4: Severe injury, with shock Blood was collected at a 0 time-point (first blood draw upon arrival at hospital) and citrate plasma was prepared, frozen and stored at -80C. FXIa, FIXa and TF activity assays were based on a response of thrombin generation to corresponding monoclonal inhibitory antibodies. RESULTS: The frequency and median concentrations of TF were relatively low in non-severe injury groups (17.5 % and 0 pM respectively) but were higher in those with severe injury (65% and 0.5 pM, respectively). While FXIa was observed in 91% of samples and was high across all 4 groups, median concentrations were highest (by approximately 4-fold) in groups with shock. FIXa was observed in 80% of plasma samples and concentrations varied in a relatively narrow range between all 4 groups. No endogenous activity was observed in plasma from healthy individuals. CONCLUSIONS: 1) Frequency and concentration of TF is higher in patients with a higher trauma severity; 2) Concentration of FXIa is higher in patients with shock; 3) For the first time reported, the vast majority of plasma samples from trauma patients contain active FIXa and FXIa. LEVEL of EVIDENCE: Diagnostic Tests or Criteria, level I. Diagnostic Tests. (C) 2017 Lippincott Williams & Wilkins, Inc.

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