Severity of anemia and hemostatic parameters are strong predictors of outcome in postoperative neurosurgical patients

OBJECTIVE: Post-operative neurosurgical patients are commonly associated with haemostatic derangements; many a times leading to development of overt disseminated intravascular coagulation (DIC) and eventually death in some of them. The present study has analysed the factors that would predict the outcome in post operative neurosurgical patients with deranged haemostatic parameters. METHODS: This is a prospective, descriptive study over a period of 15 months on 115 post operative neurosurgical patients who were clinically suspected to have DIC and investigated for the haemostatic parameters. Patients with at least one parameter abnormal were included in the study and complete data was available in 85 patients was analysed. RESULTS: Majority of deaths (22/33, 66.7%) were related to bleeding and end organ failure attributed to DIC. The most common haemostatic abnormalities found were thrombocytopenia with prolonged Prothrombin time (PT) in 48/115 (42.7%) patients. The parameters found significantly different between those who survived and those died were age, post-operative development of chest infections, severe anemia, and renal function abnormalities. Also, patient outcome correlated strongly with marked prolongation of prothrombin time (PT) and Partial thromboplastin time (PTT). However, presence of ≥3 coagulation abnormalities, presence of significant drop in haemoglobin post operatively and /or development of chest infection predicted death in postoperative neurosurgical patients with accuracy of 80.4% and this was highly significant (P = 0.000). CONCLUSION: Presence of ≥3 coagulation abnormalities, significant drop in hemoglobin post operatively and /or development of chest infection post-operatively were strong predictors of death in postoperative neurosurgical patients.