In-depth analysis of clotting dynamics in burn patients

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• 作者：Shawn Tejiram ; MD^a ; ^b ; Kathleen E. Brummel-Ziedins ; PhD^c ; Thomas Orfeo ; PhD^c ; Mihriye Mete ; PhD^d ; Sameer Desale ; BS^d ; Brittany N. Hamilton ; BS^b ; Lauren T. Moffatt ; PhD^b ; Kenneth G. Mann ; PhD^c ; Russell P. Tracy ; PhD^e ; Jeffrey W. Shupp ; MD^a ; ^b ; ^{jeffrey.w.shupp@medstar.net" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Coagulopathy ; INR ; Clotting factor ; Burn injury ; Thermal injury
• 刊名：Journal of Surgical Research
• 出版年：2016
• 出版时间：15 May 2016
• 年：2016
• 卷：202
• 期：2
• 页码：341-351
• 全文大小：1774 K

文摘

Studies associating coagulopathic changes with burn injury have relied on limited tests such as partial thromboplastin time (PTT) and international normalized ratio (INR). Understanding the clotting dynamics and associated risk factors after burn injury could influence management. This work aimed to identify real-time changes in coagulation after burn injury not indicated by PTT or INR alone.

Materials and methods

Nine burn-injured patients at a regional burn center were enrolled for blood collection at admission and set intervals over 96 h. Patient demographics, management, and laboratory data (PTT and INR) were collected. Plasma assays determined factors II, V, VII, VIII, IX, X, XI, antithrombin, and protein C functional activity as well as PAP, D-Dimer, fibrin monomer, TFPI, IL-1b, IL-6, IL-10, IL-12p.70, and TNF-α concentrations.

Results

Overall, five patients died. These patients had higher mortality scores and were more acidotic. All patients had normal coagulation studies (INR < 1.5, PTT < 45 s) within 24 h of admission, and only two were abnormal after. Increased factor VIII and IX activity were identified in seven patients at admission. Decreased antithrombin and protein C activity were seen in all patients. Patients had increased PAP, D-Dimer, and fibrin monomer concentrations throughout their hospital course. At admission, increased fold changes were seen in IL-6 (2.5–117) and IL-10 (2.4–32), whereas IL-1b and TNF-α levels were depressed in all patients.

Conclusions

Extensive changes not identified by PTT or INR were seen after burn injury that may explain perturbed coagulation in these patients. This approach further characterizes the impact thermal injury has on coagulation.