Thrombin-Antithrombin Complex and Fibrinogen Predict Microangiopathic Acute Kidney Injury in Injured Patients
In brief
Elevated TAT-to-fibrinogen ratio signals a seven-fold higher risk of acute kidney injury in trauma patients
In a study of 149 severely injured adults, a high thrombin-antithrombin to fibrinogen ratio measured six hours after injury was independently linked to AKI, achieving an AUC of 0.88 and an adjusted odds ratio of about 7. Low TAT or high fibrinogen values effectively ruled out AKI, suggesting the ratio could serve as an early bedside marker, though prospective validation is needed.
- Journal
- Blood advances (Q1)
- Published
- 1 September 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Rida Zakar, Gena V Topper, Abiha Abdullah, Morgan Mollen, Tvisha Subhasish, Reem Younes, et al.
- PMID
- 42678921
- DOI
- 10.1182/bloodadvances.2026020806
Why clinicians should know about it
- Picked for Critical Care and Intensive Care Medicine (top studies of the week, 6 September 2026): Early TAT-to-fibrinogen ratio predicts AKI
Abstract
Acute kidney injury (AKI) develops in 20-40% of critically injured patients and contributes to poor outcomes. In sepsis and critical illness, dysregulated coagulation and fibrinolysis are linked to microangiopathic kidney dysfunction, but similar relationships in trauma are not well characterized. We performed a secondary analysis of a single-center randomized controlled trial of severely injured adult trauma patients. Plasma thrombin-antithrombin (TAT), plasmin-2-antiplasmin (PAP), and fibrinogen were measured within 2 hours of injury and 6 hours later. The primary outcome was AKI, defined by the RIFLE (Risk, Injury, Failure, Loss, End-stage kidney disease) criteria. Adjusted logistic regression models evaluated biomarker associations with AKI. Receiver operating characteristic analyses identified discriminatory thresholds. Among 149 patients, 30 (20.1%) developed AKI. Patients with AKI had higher TAT and PAP concentrations and lower fibrinogen levels at both time points. The 6-hour TAT-to-fibrinogen ratio was independently associated with AKI (Adjusted OR 7.17; 95% CI 2.34-21.9, p = 0.001, AUC = 0.88). Supplemental analyses demonstrated consistent associations for TAT and fibrinogen individually, whereas PAP was not independently predictive. A 6-hour TAT level < 99 pg/mL identified patients unlikely to develop AKI (negative predictive value [NPV] 93.9%). Fibrinogen levels > 173 mg/dL showed a low likelihood of AKI (NPV 88.2%). Elevated TAT and reduced fibrinogen measured 6 hours after injury were independently associated with AKI. This suggests that early coagulation imbalance may reflect evolving microvascular kidney dysfunction in injured patients and potentially warrants the evaluation of the TAT-to-fibrinogen ratio as an early marker of trauma-related AKI. (NCT02535949).
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.