Objective: Hypothermia, metabolic acidosis, and coagulopathy are the components of the “lethal triad,” which contributes to high mortality of severe trauma. However, the important factors remain unclear. This study was performed to clarify whether these factors are correlated with the mortality of severe trauma at 24 h after the therapeutic intervention.

Materials: The retrospective study was performed from January 2012 to December 2012 in 15 Japanese hospitals.

Methods: 687 trauma patients, aged ≥18 years with an Injury Severity Score (ISS) of ≥16 were involved. Changes in the body temperature (BT), fibrinogen, prothrombin time-international normalized ratio, fibrin/fibrinogen degradation products, pH, base excess, lactate, and platelet count during 24 h after admission were analyzed, while providing adequate medical care including various therapeutic interventions such as fluid therapy, blood transfusion, and surgery. Extraneous factors such as age, sex, ISS, Revised Trauma Score, and probability of survival were also evaluated. The endpoint was 28-day survival, and all parameters were compared between the survivor (n=646) and non-survivor (n=41) groups.

Results: Age and ISS were significantly higher in the non-survivor group. The univariate analysis showed a BT increase of 1.0℃ in the survivor group relative to an increase of only 0.4℃ in the non-survivor group, indicating that BT variation contributes to survival after trauma (odds ratio, 4.07). Additionally, the increase in fibrinogen was significantly higher in the survivor than non-survivor group (54 vs. 17 mg/dl, respectively; odds ratio, 4.68). The multivariate logistic regression analysis revealed that increases in BT and fibrinogen were independent variables for 28-day survival.

Conclusion: BT and fibrinogen were independent variables for 28-day survival. In the study, these results may have suggested the importance of therapeutic interventions for the BT and coagulation in trauma patients.