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Original article
Available online 4 June 2025
Key laboratory changes in severe trauma, a different pattern for each clinical phenotype
Adrián Marcos-Moralesa,c,
Corresponding author
adrian.marcos@salud.madrid.org

Corresponding author.
, Jesús Abelardo Barea Mendozaa, Marcos Valiente Fernándeza, Carlos García Fuentesa, Fernando Calvo Boyerob, Cecilia Cueto-Felguerosob, Judith Gutiérrez Gutiérreza, Francisco de Paula Delgado Moyaa, Carolina Mudarra Rechea, Susana Bermejo Aznáreza, Alfonso Lagaresc,d, Mario Chico Fernándeza
a Intensive Care Department, Trauma and Emergency Unit, Hospital Universitario 12 de Octubre, Madrid, Spain
b Biochemistry Department, Hospital Universitario 12 de Octubre, Madrid, Spain
c Fundación de Investigación Biomédica, Instituto de Investigación i+12, Hospital Universitario 12 de Octubre, Madrid, Spain
d Neurosurgery Department, Hospital Universitario 12 de Octubre, Madrid, Spain
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Tables (3)
Table 1. Baseline patient characteristics for each study group.
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Table 2. Laboratory mean values at 0 and 24 h time points for the three study groups, and statistical comparison.
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Table 3. Overall picture of most salient laboratory value changes between study groups.
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Abstract
Objective

to compare the different evolution of conventional laboratory parameters between three severe trauma phenotypes.

Design

Observational study of a prospectively collected cohort of severe trauma patients, with retrospective database completion, studied between 2012 and 2022.

Setting

A trauma intensive care unit (ICU).

Patients

Severe trauma patients were defined by an Abbreviated Injury Scale of ≥ 3 in at least one aspect. Three groups were stablished according to hemodynamic status and Glasgow coma scale (GCS), and they were subsequently subdivided in prematurely deceased and survivors after > 72 h (h). Laboratory parameters were followed up to 96 h, statistical analysis between groups and subgroups was performed at 0 and 24 h.

Interventions

None.

Main variables of interest

Prehospital, clinical variables on admission, prognostic variables (prospective gathering); blood count, biochemistry, coagulation, blood gas analysis (retrospectively collected).

Results

1631 patients were included, 8% prematurely deceased. Initial leukocytosis and hyperglycemia were common in all groups. Hemodynamically stable patients with a GCS < 14 stood out due to a high neutrophil-to-lymphocyte ratio (NLR) and hypernatremia, both of them at 24 h, together with initial coagulopathy in the prematurely deceased. Hemodynamically unstable patients exhibited an initial pattern of lactic acidosis, coagulopathy, and decreased platelet-to-lymphocyte ratio, hemoglobin, albumin and calcium, all these changes being most prominent in the prematurely deceased. A 24 h peak in NLR was found in both the hemodynamically unstable and GCS < 14 groups.

Conclusion

Evolution of laboratory parameters differ according to the patient’s phenotype. They complete the initial severity evaluation and in hemodynamically stable patients they act as a warning for potential neurological damage.

Keywords:
Severe trauma
Biomarkers
Laboratory
Phenotypes
Neutrophil-to-lymphocyte ratio
Resumen
Objetivo

Comparar la evolución de parámetros convencionales de laboratorio en tres fenotipos de pacientes con trauma grave.

Diseño

Estudio sobre cohorte recogida prospectivamente entre 2012 y 2022 y completada retrospectivamente con valores analíticos.

Ámbito

Unidad de cuidados intensivos especializada en trauma.

Pacientes

Pacientes con trauma grave definidos por Abbreviated Injury Scale de ≥ 3 en al menos un área. Clasificados en tres grupos según situación hemodinámica (HD) y escala de coma de Glasgow (GCS); después subdivididos en fallecidos precozmente y supervivientes tras 72 horas (h). Se siguieron los valores analíticos 4 días y se compararon a las 0 y 24 h entre grupos y subgrupos.

Intervenciones

Ninguna.

Variables de interés principales

Prehospitalarias, variables clínicas al ingreso, variables pronósticas (recogida prospectiva); hemograma, bioquímica, coagulación, gasometría (retrospectivamente).

Resultados

Se incluyeron 1631 pacientes, 8% fallecieron precozmente. Leucocitosis e hiperglucemia iniciales ocurrieron en todos los grupos. Pacientes estables HD con GCS < 14 destacaron por un ratio neutófilo-linfocito (NLR) elevado e hipernatremia ambos a las 24 h, así como por coagulopatía inicial en fallecidos precozmente. Pacientes inestables HD mostraron un patrón inicial de acidosis láctica, coagulopatía, y disminución de ratio plaqueta-linfocito, hemoglobina, albúmina y calcio, todos estos cambios siendo más marcados en los precozmente fallecidos. El pico de NLR a las 24 h se encontró tanto en inestables HD como en aquellos con GCS < 14.

Conclusiones

El patrón analítico difiere en cada fenotipo de paciente. Completa la valoración inicial de la gravedad y en pacientes con estabilidad hemodinámica puede alertar sobre una posible lesión neurológica.

Palabras clave:
Trauma grave
Biomarcadores
Laboratorio
Fenotipos
Ratio neutrófilo-linfocito

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