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Volume 40 Issue 8
Aug.  2024
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Article Navigation >  CHINESE JOURNAL OF BURNS AND WOUNDS  > 2024  >  40(8): 740-745
Li Q,Ba T,Cao SJ,et al.Diagnostic value of thromboelastography combined with conventional coagulation test for trauma-induced coagulopathy in patients with electric burns in the early stage[J].Chin J Burns Wounds,2024,40(8):740-745.DOI: 10.3760/cma.j.cn501225-20240416-00135.
Citation: Li Q,Ba T,Cao SJ,et al.Diagnostic value of thromboelastography combined with conventional coagulation test for trauma-induced coagulopathy in patients with electric burns in the early stage[J].Chin J Burns Wounds,2024,40(8):740-745.DOI: 10.3760/cma.j.cn501225-20240416-00135.
shu

Diagnostic value of thromboelastography combined with conventional coagulation test for trauma-induced coagulopathy in patients with electric burns in the early stage

doi: 10.3760/cma.j.cn501225-20240416-00135

  • Department of Burn Surgery, the Third Affiliated Hospital of Inner Mongolia Medical University, Burn Medical Institute of Inner Mongolia, Baotou 014010, China

Funds:

Science and Technology Program of the Joint Fund of Scientific Research for the Public Hospitals of Health Commission of Inner Mongolia Autonomous Region 2023GLLH0245

Inner Mongolia Natural Science Foundation 2021MS08066

Inner Mongolia Medical University Joint Project YKD2024LH015

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    Abstract
  •   Objective  To explore the diagnostic value of thromboelastography (TEG) combined with conventional coagulation test (CCT) for trauma-induced coagulopathy (TIC) in patients with electric burns in the early stage.  Methods  This study was a retrospective case series research. From February 2018 to February 2024, the clinical data of 128 electric burn patients and 118 thermal burn patients who met the inclusion criteria and admitted to the Department of Burn Surgery of the Third Affiliated Hospital of Inner Mongolia Medical University were collected, including 224 males and 22 females, aged (38±14) years. The patients were divided into electric burn group (128 cases) and thermal burn group (118 cases) according to their injuries. The incidence of TIC, the indicators of CCT, including prothrombin time, activated partial thromboplastin time, thrombin time, fibrinogen level, D-dimer level, platelet count, and the detection indicators of TEG, including coagulation reaction time, K value, coagulation angle, maximum thrombus amplitude, comprehensive coagulation index, and lysis rate at 30 minutes after maximum amplitude within 8 hours of admission were compared between the two groups of patients. The Kappa test was used to analyze the consistency between CCT and TEG in diagnosing TIC in patients with electric burns in the early stage after burns. The receiver operating characteristic curves of CCT, TEG, and TEG combined with CCT in diagnosing TIC in 128 patients with electric burns were drawn, and the area under the curve (AUC), the maximum Jordan index, and sensitivity and specificity at this time were calculated.  Results  The proportion of patients diagnosed with TIC in electric burn group was 19.5% (25/128) within 8 hours of admission, which was significantly higher than 10.2% (12/118) in thermal burn group (χ2=4.21, P<0.05). Compared with those in thermal burn group, prothrombin time was significantly shortened (t=-2.32, P<0.05), D-dimer level, fibrinogen level, and platelet count were significantly increased (with Z values of -2.11 and -4.16, respectively, t=4.69, P<0.05), the coagulation reaction time was significantly shortened (t=-2.51, P<0.05), and the maximum thrombus amplitude and lysis rate at 30 minutes after the maximum amplitude were significantly increased (with t values of 2.50 and 2.10, respectively, P<0.05) in patients in electric burn group within 8 hours of admission. There were no statistically significant differences in the other CCT indicators and TEG detection indicators between the two groups of patients (P>0.05). The CCT and TEG showed high consistency in the diagnosis of TIC in patients with electric burns in the early stage after burns (Kappa=0.63, P<0.05). The AUCs of TEG combined with CCT, TEG, and CCT in diagnosis of TIC in 128 patients with electric burns were 0.92, 0.84, and 0.77 (with 95% confidence intervals of 0.86-0.97, 0.71-0.97, and 0.71-0.97, respectively), with the maximum Jordan indexes of 0.86, 0.57, and 0.65. At this time, the specificity was 93.7%, 83.2%, and 88.2%, respectively, and the sensitivity was 92.3%, 87.5%, and 76.5%, respectively.  Conclusions  Patients with electric burns are in a state of hypercoagulability of coagulation system and hyperfunction of fibrinolysis system in the early stage after burns, and TEG combined with CCT can increase the diagnostic rate of TIC in patients with electric burns.

     

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    • References(33)
  • [1]
    徐文心,朱晓光,李梅芳,等.血栓弹力图对创伤性凝血病患者诊断和输血治疗的研究[J].中华急诊医学杂志,2019,28(4):504-509.DOI: 10.3760/cma.j.issn.1671-0282.2019.04.021.
    [2]
    HengX,CaiP,YuanZ,et al.Efficacy and safety of extracorporeal membrane oxygenation for burn patients: a comprehensive systematic review and meta-analysis[J/OL].Burns Trauma,2023,11:tkac056[2024-04-16].https://pubmed.ncbi.nlm.nih.gov/36873286/.DOI: 10.1093/burnst/tkac056.
    [3]
    张昕,钟林翠,吴峻,等.基于随机森林算法的创伤患者并发血栓事件危险因素分析[J].解放军医学杂志,2023,48(1):78-83.DOI: 10.11855/j.issn.0577-7402.2023.01.0078.
    [4]
    李全,巴特,曹胜军,等.电烧伤患者弥散性血管内凝血风险预测模型的建立与验证[J].中华烧伤与创面修复杂志,2023,39(8):738-745.DOI: 10.3760/cma.j.cn501225-20230419-00132.
    [5]
    VaghardoostR,SaraeeA,GhavamiY,et al.Evaluation of electrical burn injuries in Iran: a 7-year retrospective study[J].J Burn Care Res,2022,43(1):104-108.DOI: 10.1093/jbcr/irab070.
    [6]
    LiQ,ZhangT,WangL,et al.Clinical significance of R-TEG in severe burn patients with coagulation dysfunction[J].Injury,2022,53(12):3993-3999.DOI: 10.1016/j.injury.2022.09.061.
    [7]
    赵婧楠,蒋航,陈宾,等.重症烧伤患者早期凝血功能变化探究[J].中华烧伤与创面修复杂志,2023,39(11):1057-1063.DOI: 10.3760/cma.j.cn501120-20210915-00320.
    [8]
    荆晶,王文婷,常艳,等.临床凝血功能异常患者血栓弹力图与常规凝血检测的比较及相关性分析[J].中国实验血液学杂志,2020,28(2):629-635.DOI: 10.19746/j.cnki.issn1009-2137.2020.02.045.
    [9]
    罗高兴,张清荣,钱卫,等.重视烧伤后凝血异常[J].中华烧伤与创面修复杂志,2023,39(5):401-406.DOI: 10.3760/cma.j.cn501225-20221223-00545.
    [10]
    马晓媛,肖雅,陈涛,等.解剖学评分联合生理学评分对严重创伤患者并发多器官功能障碍综合征的预测价值[J].中华烧伤杂志,2016,32(2):105-108.DOI: 10.3760/cma.j.issn.1009-2587.2016.02.009.
    [11]
    BartelsP,ThammOC,ElrodJ,et al.The ABSI is dead, long live the ABSI - reliable prediction of survival in burns with a modified Abbreviated Burn Severity Index[J].Burns,2020,46(6):1272-1279.DOI: 10.1016/j.burns.2020.05.003.
    [12]
    陈国芬,彭国璇,任廷果,等.创伤凝血病的诊疗进展[J].创伤外科杂志,2021,23(9):714-717,721.DOI: 10.3969/j.issn.1009-4237.2021.09.018.
    [13]
    李继如,关文贺,王丽杰.不同实验方法诊断创伤性凝血病及危险因素分析[J].中国小儿急救医学,2020,27(11):821-825.DOI: 10.3760/cma.j.issn.1673-4912.2020.11.005.
    [14]
    ChakkaK,ClarkA,KowalskeK.We got your back: evaluating recovery following spinal cord injury after high-voltage electric burns[J].J Burn Care Res,2023,44(2):414-418.DOI: 10.1093/jbcr/irac115.
    [15]
    LiQ,WangLF,ChenQ,et al.Amputations in the burn unit: a retrospective analysis of 82 patients across 12 years[J].Burns,2017,43(7):1449-1454.DOI: 10.1016/j.burns.2017.04.005.
    [16]
    ZhangTN,BaT,LiF,et al.Coagulation dysfunction of severe burn patients: a potential cause of death[J].Burns,2023,49(3):678-687.DOI: 10.1016/j.burns.2022.05.003.
    [17]
    陆悦,卢仁泉,张杰,等.联合凝血功能指标在结直肠癌患者化疗后高凝状态监测中的应用价值[J].中国癌症杂志,2024,34(3):278-285.DOI: 10.19401/j.cnki.1007-3639.2024.03.005.
    [18]
    ButtAL,RamarapuS,KyoH,et al.In response: caution in extrapolating hypercoagulable viscoelastic coagulation test results to in vivo hemostasis[J].Transfusion,2024,64(3):563-564.DOI: 10.1111/trf.17734.
    [19]
    BallRL,KeylounJW,Brummel-ZiedinsK,et al.Burn-induced coagulopathies: a comprehensive review[J].Shock,2020,54(2):154-167.DOI: 10.1097/SHK.0000000000001484.
    [20]
    刘泽世,周谨,刘月彩,等.高压电烧伤对大鼠凝血功能的早期影响[J].中华烧伤杂志,2015,31(3):218-220.DOI: 10.3760/cma.j.issn.1009-2587.2015.03.014.
    [21]
    ZouZY,HuangJJ,LuanYY,et al.Early prophylactic anticoagulation with heparin alleviates mortality in critically ill patients with sepsis: a retrospective analysis from the MIMIC-IV database[J/OL].Burns Trauma,2022,10:tkac029[2024-04-16].https://pubmed.ncbi.nlm.nih.gov/36168402/.DOI: 10.1093/burnst/tkac029.
    [22]
    陈文达,彭娜,刘帅,等.中性粒细胞侧向荧光强度对重症中暑合并弥散性血管内凝血的早期诊断价值[J].解放军医学杂志,2023,48(4):431-436.DOI: 10.11855/j.issn.0577-7402.2023.04.0431.
    [23]
    马继中,王野平,孔敏刚,等.静脉双功超声联合红细胞分布宽度、血小板/淋巴细胞预测烧伤患者静脉血栓栓塞症的价值研究[J].浙江医学,2024,46(5):490-495.DOI: 10.12056/j.issn.1006-2785.2024.46.5.2023-1973.
    [24]
    LinJC,WuGH,ZhengJJ,et al.Prognostic values of platelet distribution width and platelet distribution width-to-platelet ratio in severe burns[J].Shock,2022,57(4):494-500.DOI: 10.1097/SHK.0000000000001890.
    [25]
    陈慧敏,姚梦雅,黄利民,等.红细胞分布宽度和血小板分布宽度联合格拉斯哥昏迷评分对重度创伤性颅脑损伤患者预后的评估价值[J].医学研究生学报,2020,33(5):493-497.DOI: 10.16571/j.cnki.1008-8199.2020.05.009.
    [26]
    付鹤鹏,张玉想,魏彦芳,等.重症创伤患者血小板/淋巴细胞比值联合血栓最大振幅与死亡的相关性分析[J].解放军医学杂志,2018,43(6):509-513.DOI: 10.11855/j.issn.0577-7402.2018.06.11.
    [27]
    张怡,卓海龙,程晨,等.血栓弹力图监测体外模拟创伤性低纤维蛋白原血症患者凝血功能变化[J].临床输血与检验,2023,25(3):363-367.DOI: 10.3969/j.issn.1671-2587.2023.03.013.
    [28]
    JohnsonBZ,StevensonAW,BarrettLW,et al.Platelets after burn injury - hemostasis and beyond[J].Platelets,2022,33(5):655-665.DOI: 10.1080/09537104.2021.1981849.
    [29]
    KoamiH,SakamotoY,MatsuokaA,et al.Thromboelastometric analysis of the correlation between burn-induced coagulopathy and severity of burn injury[J].Cureus,2024,16(2):e54489.DOI: 10.7759/cureus.54489.
    [30]
    万珍,徐俊,方强.纤维蛋白原水平对创伤性凝血病预后影响的前瞻性观察研究[J].中国急救医学,2020,40(9):829-834.DOI: 10.3969/j.issn.1002-1949.2020.09.007.
    [31]
    MooreHB,WalshM,KwaanHC,et al.The complexity of trauma-induced coagulopathy[J].Semin Thromb Hemost,2020,46(2):114-115.DOI: 10.1055/s-0040-1702202.
    [32]
    卞良,单彪,雷秋香,等.血栓弹力图检测结果影响因素及其参数与凝血功能、血小板指标相关性分析[J].临床军医杂志,2023,51(6):618-621.DOI: 10.16680/j.1671-3826.2023.06.17.
    [33]
    秦丹,周华友.血栓弹力图联合常规凝血指标在流行性出血热患者内源性肝素检测中的应用[J].中国输血杂志,2024,37(6):620-624.DOI: 10.13303/j.cjbt.issn.1004-549x.2024.06.002.
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