Association of D-dimer, fibrin degradation products, and coagulation parameters with progressive hemorrhagic injury following traumatic brain injury

This study aimed to evaluate the predictive value of coagulation biomarkers, particularly D-dimer and fibrin degradation products (FDP), in the development of secondary progressive hemorrhagic injury (PHI) following traumatic brain injury (TBI). We conducted a retrospective cohort study based on hospital medical record data. All enrolled TBI patients were divided into a PHI group (n = 51) and a non-PHI group (n = 151) for comparison based on whether PHI occurred during hospitalization. Comprehensive coagulation profiles, including D-dimer, FDP, Prothrombin time, thrombin time, fibrinogen (FIB), and activated partial thromboplastin time (APTT), were analyzed. Multivariate logistic regression was performed to identify independent risk factors. The incidence of PHI was 25.25% (51/202). PHI patients demonstrated significantly higher systolic blood pressure (154.00 mm Hg vs 139.00 mm Hg, P = .002) and longer hospital stays (20.00 days vs 13.00 days, P = .007). Coagulation analysis revealed lower FIB (2.75 g/L vs 3.04 g/L, P = .021) and APTT (28.90 seconds vs 29.90 seconds, P = .048), but markedly elevated D-dimer (9162.00 ng/mL vs 3191.00 ng/mL, P = .001) and FDP levels (73.77 μg/mL vs 22.19 μg/mL, P = .003) in the PHI group. Logistic regression identified Glasgow Coma Scale score as an independent risk factor [adjusted odds ratio = 1.558, 95% confidence interval = 1.056–2.298, P = .025] and APTT as a protective factor (odds ratio = 0.937, 95% confidence interval = 0.915–0.959, P < .001) of secondary PHI in patients with TBI. Coagulation dysfunction, characterized by elevated D-dimer and FDP and decreased FIB, was significantly associated with PHI development in TBI patients. Multivariable logistic regression revealed that only Glasgow Coma Scale score and APTT remained significant and were independent predictors of secondary PHI.