Thrombin-antithrombin complex and fibrinogen predict microangiopathic acute kidney injury in patients with traumatic injuries.
Rida Zakar, Gena V Topper, Abiha Abdullah et al.
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In 30 seconds
This secondary analysis of a single-center randomized controlled trial examined whether early coagulation and fibrinolysis biomarkers were associated with acute kidney injury (AKI) in adults with severe traumatic injuries. Among 149 patients, 30 (20.1%) developed AKI. At 6 hours after injury, the thrombin-antithrombin (TAT)-to-fibrinogen ratio was independently associated with AKI (adjusted odds ratio, 7.17; 95% confidence interval, 2.34-21.9; P = .001; area under the curve = 0.88). The findings suggest that early coagulation imbalance may reflect evolving microvascular kidney dysfunction after trauma.
Key findings
- AKI occurred in 30 of 149 patients (20.1%).
- The 6-hour TAT-to-fibrinogen ratio was independently associated with AKI (adjusted odds ratio, 7.17; 95% confidence interval, 2.34-21.9; P = .001; area under the curve = 0.88).
- A 6-hour TAT level of <99 pg/mL identified patients unlikely to develop AKI (negative predictive value [NPV], 93.9%).
- Fibrinogen levels of >173 mg/dL were associated with a low likelihood of AKI (NPV, 88.2%); PAP was not independently predictive.
Why it matters
AKI is a consequential complication of traumatic injury, and these results link early coagulation imbalance with subsequent kidney injury. If validated, the TAT-to-fibrinogen ratio could help identify patients at risk soon after injury and support investigation of microvascular mechanisms in trauma-related AKI.
What to keep in mind
This was a secondary analysis of a single-center trial, and the biomarker thresholds were evaluated in the same cohort; external validation is not reported in the abstract.