Shawn Tejiram1, Kathleen E Brummel-Ziedins2, Thomas Orfeo2, Mihriye Mete3, Sameer Desale3, Brittany N Hamilton4, Lauren T Moffatt4, Kenneth G Mann2, Russell P Tracy5, Jeffrey W Shupp6. 1. Department of Surgery, The Burn Center, MedStar Washington Hospital Center, Washington, DC; Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, DC. 2. Department of Biochemistry, University of Vermont, Colchester, Vermont. 3. Biostatistics and Bioinformatics Department, MedStar Health Research Institute, Hyattsville, Maryland. 4. Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, DC. 5. Department of Pathology and Laboratory Medicine, University of Vermont, Colchester, Vermont. 6. Department of Surgery, The Burn Center, MedStar Washington Hospital Center, Washington, DC; Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, DC. Electronic address: jeffrey.w.shupp@medstar.net.
Abstract
BACKGROUND: 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.
BACKGROUND: 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.
Authors: Shawn Tejiram; Soman Sen; Kathleen S Romanowski; David G Greenhalgh; Tina L Palmieri Journal: J Burn Care Res Date: 2020-05-02 Impact factor: 1.845
Authors: Robert L Ball; John W Keyloun; Kathleen Brummel-Ziedins; Thomas Orfeo; Tina L Palmieri; Laura S Johnson; Lauren T Moffatt; Anthony E Pusateri; Jeffrey W Shupp Journal: Shock Date: 2020-08 Impact factor: 3.533
Authors: John W Keyloun; Tuan D Le; Anthony E Pusateri; Robert L Ball; Bonnie C Carney; Thomas Orfeo; Kathleen E Brummel-Ziedins; Maria C Bravo; Melissa M McLawhorn; Lauren T Moffatt; Jeffrey W Shupp Journal: Shock Date: 2021-08-01 Impact factor: 3.533
Authors: Jeffrey W Shupp; Kathleen E Brummel-Ziedins; Mitchell J Cohen; Kalev Freeman; Rasha Hammamieh; Uma S Mudunuri; Thomas Orfeo; Lauren T Moffatt; Bernard H Brownstein; Kenneth G Mann; Marti Jett; Anthony E Pusateri Journal: Shock Date: 2019-10 Impact factor: 3.454
Authors: Liam D Cato; Benjamin Bailiff; Joshua Price; Christos Ermogeneous; Jon Hazeldine; William Lester; Gillian Lowe; Christopher Wearn; Jonathan R B Bishop; Janet M Lord; Naiem Moiemen; Paul Harrison Journal: Burns Trauma Date: 2021-10-20