Email Alerts
RSS
Volume 39 Issue 11
Nov.  2023
Turn off MathJax
Article Contents
Article Navigation >  CHINESE JOURNAL OF BURNS AND WOUNDS  > 2023  >  39(11): 1057-1063
Zhao JN,Jiang H,Chen B,et al.Exploration of the changes of early coagulation function in patients with severe burns[J].Chin J Burns Wounds,2023,39(11):1057-1063.DOI: 10.3760/cma.j.cn501120-20210915-00320.
Citation: Zhao JN,Jiang H,Chen B,et al.Exploration of the changes of early coagulation function in patients with severe burns[J].Chin J Burns Wounds,2023,39(11):1057-1063.DOI: 10.3760/cma.j.cn501120-20210915-00320.
shu

Exploration of the changes of early coagulation function in patients with severe burns

doi: 10.3760/cma.j.cn501120-20210915-00320

  • Department of Burns and Plastic Surgery, Guangzhou Red Cross Hospital of Jinan University, Guangzhou 510220, China

More Information
  • Corresponding author: Li Xiaojian, Email: lixj64@163.com
  • Received Date: 2021-09-15
    Abstract
  •   Objective   To study the changes of early (i.e., within post injury day (PID) 14) coagulation function in patients with severe burns.   Methods   A retrospective case series study was conducted. From December 2018 to December 2019, 50 severe burn patients who met the inclusion criteria were admitted to Guangzhou Red Cross Hospital of Jinan University. According to the severity of burns, the patients were divided into severe burn group (17 cases, including 12 males and 5 females) and extremely severe burn group (33 cases, including 26 males and 7 females). The platelet count (PLT), and conventional coagulation indexe and thromboelastogram index levels of patients were collected at admission, post injury hour (PIH) 48 and 72, and on PID 7 and 14. The conventional coagulation indexes included prothrombin time (PT), thrombin time (TT), activated partial prothrombin time (APTT), and fibrinogen (FIB) and D-dimer levels. The thromboelastogram indexes included coagulation angle (i.e., α angle), coagulation composite index (CI), MA value, R value, and K value (reflecting maximum amplitude, coagulation reaction time, and blood agglutination time, respectively). Data were statistically analyzed with independent sample t-test, Wilcoxon rank sum test, and chi-square test. Verification of the mixed effect model was performed on each index data of patients in the two groups, while the repeated measures analysis of variance was performed on PLT. Pearson correlation analysis or Spearman correlation analysis were performed to analyze the correlation between the thromboelastogram index data (except CI) and the PLT and conventional coagulation index data, respectively.   Results   At admission, PIH 48 and 72, and on PID 7 and 14, PLT of patients in severe burn group were (203±91), (148±70), (123±63), (203±62), (402±140)×10 9/L, respectively, PLT of patients in extremely severe burn group were (235±116), (145±71), (109±52), (235±106), (455±138)×10 9/L, respectively. In overall comparison, only the difference of the main effect of time factor was statistically significant ( F=92.55, P<0.05). In severe burn group, statistically significant differences were only identified in comparison of patients' PLT between PID 7 and the adjacent two time points (at PIH 72 and on PID 14, with both P values <0.05). The differences in PLT of patients between all the adjacent time points in extremely severe burn group were statistically significant ( P<0.05). In the overall comparison of PT, TT, and FIB level of patients in the two groups at each time point, only the difference of main effect of time factor was statistically significant (with F values of 6.04, 8.45, and 32.90, respectively, all P values <0.05), and APTT and FIB level of patients in extremely severe burn group within PID 14 were higher than those in severe burn group. There were statistically significant differences in MA value, α angle, K value, and CI of patients in the two groups at each time point (with F values of 18.82, 11.38, 9.11, and 9.42, respectively, all P values <0.05). MA value was moderately correlated with PLT ( r=0.69, P<0.05), weakly correlated with TT and FIB level (with r values of -0.29 and 0.30 respectively, P<0.05), and very weakly correlated with D-dimer level ( r=-0.15, P<0.05); α angle was moderately correlated with PLT ( r=0.58, P<0.05), and weakly correlated with FIB level and TT (with r values of 0.26 and -0.29, respectively, P<0.05); R value was weakly correlated with APTT and FIB level (with r values of 0.24 and 0.31, respectively, P<0.05), and very weakly correlated with PT and TT (with r values of 0.16 and 0.14, respectively, P<0.05); K value was moderately correlated with PLT ( r=-0.59, P<0.05), and weakly correlated with FIB and TT (with r values of -0.29 and 0.32, respectively, P<0.05), and very weakly correlated with D-dimer level ( r=-0.15, P<0.05).   Conclusions   Severe burn patients are already characterized with coagulation function changes in early stage, including insufficiency of coagulation function, enhanced platelet aggregation ability and enhanced FIB function. There is a certain correlation between conventional coagulation indexes and thromboelastogram indexes, but they cannot replace each other.

     

    • FullText(HTML)
  • loading
    • References(22)
  • [1]
    SherrenPB, HusseyJ, MartinR, et al. Lethal triad in severe burns[J]. Burns, 2014, 40(8):1492-1496. DOI: 10.1016/j.burns.2014.04.011.
    [2]
    杨宗城.烧伤治疗学[M].3版.北京:人民卫生出版社,2006.
    [3]
    GajbhiyeAS, MeshramMM, KathodAP. Platelet count as a prognostic indicator in burn septicemia[J]. Indian J Surg, 2013,75(6):444-448. DOI: 10.1007/s12262-012-0532-6.
    [4]
    GlasGJ, LeviM, SchultzMJ. Coagulopathy and its management in patients with severe burns[J]. J Thromb Haemost, 2016,14(5):865-874. DOI: 10.1111/jth.13283.
    [5]
    LavrentievaA, KontakiotisT, BitzaniM, et al. Early coagulation disorders after severe burn injury: impact on mortality[J]. Intensive Care Med, 2008,34(4):700-706. DOI: 10.1007/s00134-007-0976-5.
    [6]
    张庆富. 烧伤医学中的微循环问题[J/CD].中华损伤与修复杂志(电子版),2008,3(5):546-551. DOI: 10.3969/j.issn.1673-9450.2008.05.002.
    [7]
    夏照帆, 朱峰. 重视危重烧伤凝血障碍的诊治[J].医学研究生学报,2018,31(8):785-789. DOI: 10.16571/j.cnki.1008-8199.2018.08.001.
    [8]
    MitraB, WasiakJ, CameronPA, et al. Early coagulopathy of major burns[J]. Injury, 2013,44(1):40-43. DOI: 10.1016/j.injury.2012.05.010.
    [9]
    SherrenPB, HusseyJ, MartinR, et al. Acute burn induced coagulopathy[J]. Burns, 2013,39(6):1157-1161. DOI: 10.1016/j.burns.2013.02.010.
    [10]
    MarsdenNJ, VanM, DeanS, et al. Measuring coagulation in burns: an evidence-based systematic review[J]. Scars Burn Heal, 2017,3:2059513117728201. DOI: 10.1177/2059513117728201.
    [11]
    KimSM, KimSI, YuG, et al. Role of thromboelastography in the evaluation of septic shock patients with normal prothrombin time and activated partial thromboplastin time[J]. Sci Rep, 2021,11(1):11833. DOI: 10.1038/s41598-021-91221-3.
    [12]
    BallRL, KeylounJW, Brummel-ZiedinsK, et al. Burn-induced coagulopathies: a comprehensive review[J]. Shock, 2020,54(2):154-167. DOI: 10.1097/SHK.0000000000001484.
    [13]
    GuoF, WangX, HuanJ, et al. Association of platelet counts decline and mortality in severely burnt patients[J]. J Crit Care, 2012,27(5):529.e1-e7. DOI: 10.1016/j.jcrc.2011.12.006.
    [14]
    MarckRE, MontagneHL, TuinebreijerWE, et al. Time course of thrombocytes in burn patients and its predictive value for outcome[J]. Burns, 2013,39(4):714-722. DOI: 10.1016/j.burns.2013.01.015.
    [15]
    NurdenAT. Platelets, inflammation and tissue regeneration[J]. Thromb Haemost, 2011, 105 Suppl 1:S13-33. DOI: 10.1160/THS10-11-0720.
    [16]
    AkamatsuN, SugawaraY, KanakoJ, et al. Low platelet counts and prolonged prothrombin time early after operation predict the 90 days morbidity and mortality in living-donor liver transplantation[J]. Ann Surg, 2017,265(1):166-172. DOI: 10.1097/SLA.0000000000001634.
    [17]
    CatoLD, WearnCM, BishopJ, et al. Platelet count: a predictor of sepsis and mortality in severe burns[J]. Burns, 2018,44(2):288-297. DOI: 10.1016/j.burns.2017.08.015.
    [18]
    ThachilJ, WarkentinTE. How do we approach thrombocytopenia in critically ill patients?[J]. Br J Haematol, 2017,177(1):27-38. DOI: 10.1111/bjh.14482.
    [19]
    HuangYS, YangZC, LiuXS, et al. Serial experimental and clinical studies on the pathogenesis of multiple organ dysfunction syndrome (MODS) in severe burns[J]. Burns, 1998,24(8):706-716. DOI: 10.1016/s0305-4179(98)00123-5.
    [20]
    翁志勇, 付晋凤. 血小板活化因子在烧伤后的变化与作用[J].标记免疫分析与临床,2010,17(1):60-62. DOI: 10.3969/j.issn.1006-1703.2010.01.027.
    [21]
    YinZ, BeiwenW, ZhenzhuM, et al. Characteristics of bloodstream infection and initial antibiotic use in critically ill burn patients and their impact on patient prognosis[J]. Sci Rep, 2022,12(1):20105. DOI: 10.1038/s41598-022-24492-z.
    [22]
    KorkmazHI, FlokstraG, WaasdorpM, et al. The Complexity of the post-burn immune response: an overview of the associated local and systemic complications[J]. Cells, 2023, 12(3):345. DOI: 10.3390/cells12030345.
    • Relative Articles
    • Supplements(0)
    • Cited By
  • 加载中

Catalog

    通讯作者: 陈斌, bchen63@163.com
    • 1. 

      沈阳化工大学材料科学与工程学院 沈阳 110142

    1. 本站搜索
    2. 百度学术搜索
    3. 万方数据库搜索
    4. CNKI搜索

    Figures(1)  / Tables(2)

    Get Citation
    PDF
    XML

    Article Metrics

    Article views (193) PDF downloads(25) Cited by()
    Proportional views
    Related

    Copyright © Chinese Journal of Burns京ICP备07035254号-14

    E-mail：shaoshangzazhi@163.com

    Website：https://zhsszz.xml-journal.net/

    Supported by: Beijing Renhe Information Technology Co. Ltd    

    /

    DownLoad:  Full-Size Img  PowerPoint
    Return
    Return