Prothrombin Time as a Mirror of Immunological Capability in Polytrauma Patients, An IBM Watson Trauma Pathway Explorer© Analysis and Statistical Proof of Sepsis

Author(s): Philipp Vetter, Nikolas Wolf, Jan Hambrecht, Cédric Niggli, Jindrich Vomela, Hans-Christoph Pape, Ladislav Mica

Triaging plays a pivotal role in the trauma bay after admission of polytrauma patients. The Watson Trauma Pathway Explorer® is an outcome prediction tool for Systemic Inflammatory Response Syndrome and sepsis within 21 days and death within 72 h in those patients. We aimed to analyze the time-related value of prothrombin time (PT) as sign of coagulopathy for sepsis. Retrospective data of 3653 patients were analyzed. According to sepsis development, two groups were formed. PT was generally measured until up to 48 h after admission to our trauma bay. Group differences were tested, and PT was analyzed as an independent predictor for sepsis, corrected for injury severity. Time-related threshold between groups were defined. Significant differences (p < 0.05) in PT between groups existed from admission over an hour and from 24 h to 48 h after admission. PT reached a minimum at 2 h after admission (60%) and normalized thereafter. The PT represented an independent predictor of sepsis at 24 h (PT: 86%; p = 0.002) and 48 h (PT: 91%; p < 0.001) after admission. A PT of ≤ 50% was predictive at admission (p < 0.001) and tended to be predictive at 4 h after admission (p = 0.068). A PT of ≤ 25% was predictive at admission (p = 0.011). Threshold values reached a minimum at 2 h after admission (PT: 57%), normalizing thereafter. The results highlight the time-related role of PT for sepsis in polytrauma patients. Thereby re-assessment is enabled, and early appropriate measures are facilitated.