Abstract
Introduction
The aim of this study was to retrospectively analyze Thrombelastography (TEG) data
of severe burn patients to provide a clinical basis for timely diagnosis and treatment
of coagulation dysfunction.
Methods
The present study comprised burn patients with full thickness TBSA ≥ 60%. The patients
included in the study were admitted to the Third Affiliated Hospital of Inner Mongolia
Medical University between March 2019 and March 2022 and died within 10 days. Patient
demographic and clinical data, including abbreviated burn severity index (ABSI) score,
full thickness and overall total surface burn area (TBSA), injury cause, International
Society on Thrombosis and Hemostasis (ISTH) score, were retrieved from the electronic
medical record system. TEG data (including ACT, K, α, MA and LY30), platelet count
(PLT), mean platelet volume (MPV) and platelet distribution width (PDW) data were
obtained from the records of included patients for analysis.
Results
A total of 9 patients were enrolled. The average burn area was 90.0% TBSA and the
full-thickness TBSA was 72.0%. The results showed that α, MA and PLT count values
were significantly lower relative to those at obtained throughout admission period
(all p < 0.05). PDW and MPV were significantly higher compared with the values at admission
(all p < 0.05). ACT time was significantly longer from day 2 after severe burn compared with
the ACT time at admission (all p < 0.05). LY30 value from day 3 after severe burn was significantly higher compared
with the value at admission (p < 0.05). One patient was diagnosed with diffuse intravascular coagulation (DIC) on
admission, whereas eight patients were diagnosed with DIC on the day of death.
Conclusion
Coagulation dysfunction after severe burn is mainly characterized by procoagulant
disorders and hyperfibrinolysis, which can be timely detected by TEG. Coagulation
after severe burn exhibits a gradual aggravation, and can lead to death of patients.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to InjuryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Low-dose hydrocortisone reduces norepinephrine duration in severe burn patients: a randomized clinical trial.Crit Care. 2015; 19: 21
- Coagulopathy and its management in patients with severe burns.J Thromb Haemost. 2016; 14: 865-874
- Lethal triad in severe burns.Burns. 2014; 40: 1492-1496
- The pathogenesis of traumatic coagulopathy.Anaesthesia. 2015; 70 (Suppl 1e32-4): 96-101
- Major burn injury is not associated with acute traumatic coagulopathy.J Trauma Acute Care Surg. 2013; 74: 1474-1479
- Differentiating disseminated intravascular coagulation (DIC) with the fibrinolytic phenotype from coagulopathy of trauma and acute coagulopathy of trauma-shock (COT/ACOTS).J Thromb Haemost. 2013; 11: 826-835
- High D-dimer levels predict a poor outcome in patients with severe trauma, even with high fibrinogen levels on arrival: A multicenter retrospective study.Shock. 2016; 45: 308-314
- Early coagulopathy of major burns.Injury. 2013; 44: 40-43
- Thrombin generation in patients with severe thermal injury.Burns. 2019; 45: 54-62
- American burn association practice guidelines for prevention, diagnosis, and treatment of ventilator-associated pneumonia (VAP) in burn patients.J Burn Care Res. 2009; 30: 910-928
- Thrombelastography/thromboelastometry.Clin Lab Haematol. 2005; 27: 81-90
- Comparison between thrombelastography and thromboelastometry in hyperfibrinolysis detection during adult liver transplantation.Br J Anaesth. 2016; 116: 507-512
- Burn-induced coagulopathies: a comprehensive review.Shock. 2020; 54: 154-167
- Rapid thrombelastography delivers real-time results that predict transfusion within 1 hour of admission.J Trauma. 2011; 71 (discussion 414-7): 407-414
- Disseminated intravascular coagulation.Nat Rev Dis Primers. 2016; 2: 16037
- Burn injury in Mottahari Burn Center in Tehran, Iran.World J Plast Surg. 2016; 5: 77-79
- Hypercoagulability after burn injury.J Trauma Acute Care Surg. 2013; 75 (discussion 43): 37-43
- Admission rapid thrombelastography (rTEG(R)) values predict resuscitation volumes and patient outcomes after thermal injury.J Burn Care Res. 2018; 39: 345-352
- The pathophysiology of trauma-induced coagulopathy.Curr Opin Crit Care. 2012; 18: 631-636
- Thrombelastography and rotational thromboelastometry early amplitudes in 182 trauma patients with clinical suspicion of severe injury.J Trauma Acute Care Surg. 2014; 76: 682-690
- Targeted coagulation management in severe trauma: the controversies and the evidence.Anesth Analg. 2016; 123: 910-924
- The European guideline on management of major bleeding and coagulopathy following trauma: fifth edition.Crit Care. 2019; 23: 98
- Cardiac dysfunction after burns.Burns. 2008; 34: 603-609
- Normal platelet function.Cancer Metastasis Rev. 2017; 36: 195-198
- Platelet count: a predictor of sepsis and mortality in severe burns.Burns. 2018; 44: 288-297
- Platelets in defense against bacterial pathogens.Cell Mol Life Sci. 2010; 67: 525-544
- Intraoperative and postoperative effects of TEG-guided platelet transfusion on antiplatelet drug-related intracerebral hemorrhage patients.Exp Ther Med. 2019; 17: 2263-2267
- The clinical utility of fibrin-related biomarkers in sepsis.Blood Coagul Fibrinolysis. 2013; 24: 839-843
- Mortality and causes of death in a burn centre.Burns. 2008; 34: 1103-1107
- Sepsis-induced coagulopathy and disseminated intravascular coagulation.Anesthesiology. 2020; 132: 1238-1245
- Role of thromboelastography as an early predictor of disseminated intravascular coagulation in patients with septic shock.J Clin Med. 2020; 9: 3883
Article Info
Publication History
Published online: October 02, 2022
Accepted:
September 29,
2022
Identification
Copyright
© 2022 Elsevier Ltd. All rights reserved.
