Histone-Complexed DNA Fragments Levels are Associated with Coagulopathy, Endothelial Cell Damage, and Increased Mortality after Severe Pediatric Trauma

Shock
Robert T RussellJean-François Pittet

Abstract

The release of damage-associated molecular pattern molecules in the extracellular space secondary to injury has been shown to cause systemic activation of the coagulation system and endothelial cell damage. We hypothesized that pediatric trauma patients with increased levels of histone-complexed DNA fragments (hcDNA) would have evidence of coagulopathy and endothelial damage that would be associated with poor outcomes. We conducted a prospective observational study of 149 pediatric trauma patients and 62 control patients at two level 1 pediatric trauma centers from 2013 to 2016. Blood samples were collected upon arrival and at 24 h, analyzed for hcDNA, coagulation abnormalities, endothelial damage, and clinical outcome. Platelet aggregation was assessed with impedance aggregometry (Multiplate) and coagulation parameters were assessed by measuring prothrombin time ratio in plasma and the use of viscoelastic techniques (Rotational Thromboelastometry) in whole blood. The median age was 8.3 years, the median injury severity score (ISS) was 20, and overall mortality was 10%. Significantly higher levels of hcDNA were found on admission in patients with severe injury (ISS > 25), coagulopathy, and/or abnormal platelet aggregation. Pati...Continue Reading

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Citations

Apr 2, 2020·JCI Insight·Danielle S GruenUNKNOWN PAMPer study group
Mar 9, 2019·American Journal of Physiology. Heart and Circulatory Physiology·Daniel M CollierKalev Freeman
Dec 19, 2017·Shock·Marcin F Osuchowski
Jan 22, 2021·Blood·Christian Con Yost
Feb 18, 2021·Acta Anaesthesiologica Scandinavica·Robert G HahnRandal O Dull

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