Abstract
<jats:p>Objective: To establish the prognostic significance of changes in hemostasis parameters and systemic inflammation markers during the first 72 hours at the fifth stage of medical care for assessing the risk of mortality in patients with severe combined trauma. Material and Methods: Data from 59 patients with severe combined trauma (ISS ≥20) admitted to the intensive care unit on the 6th [5–8th] day after injury were analyzed. Patients were divided into groups of survivors (n = 37) and deceased (n = 22). Clinical and laboratory parameters were assessed upon admission and on the 3rd day. Results: at admission, the groups differed in the severity of thrombocytopenia (98.9 [71.5; 186.9] versus 185.0 [113.8; 279.5] ×10⁹/l, p = 0.011) and hypocoagulation as measured by a decrease in the prothrombin index (PTI) (70.9 [48.8; 83.5] versus 93.2 [66.0; 112.5] %, p = 0.004). By the 3rd day, hypocoagulation persisted in the group of deceased (PTI 73.5 ± 18.5 % versus 99.6 ± 27.0 %, p < 0.001) against the background of a significant increase in the level of C-reactive protein (CRP) (213.2 ± 110.2 mg/l versus 147.5 ± 72.1 mg/l, p = 0.014). Multivariate analysis revealed independent predictors of mortality: thrombocytopenia (<150 × 10⁹/L; OR = 3.91; 95 % CI: 1.25–12.91; p = 0.02), high SOFA score (OR = 1.17; 95 % CI: 1.01–1.36; p = 0.03), and decreased PTI (<76 %; OR = 3.52; 95 % CI: 1.15–10.75; p = 0.03). Conclusion: in patients with severe concomitant trauma, poor outcome in the late stages of treatment is associated with progression of coagulopathy against the background of increasing systemic inflammation, which indicates the development of secondary sepsis-associated coagulopathy. Monitoring platelet, PTI, CRP, and procalcitonin dynamics in the first 72 hours allows for risk stratification and timely therapy adjustments.</jats:p>