Early coagulation changes as predictors of adverse outcomes in patients with severe burn and inhalation injuries

IF 3.2 3区医学 Q2 CRITICAL CARE MEDICINE

Burns Pub Date : 2025-01-03 DOI:10.1016/j.burns.2025.107373

Shengyu Huang , Dan Wang , Qimin Ma , Tuo Shen , Dinghong Min , Yusong Wang , Xincheng Liao , Rui Liu , Haiming Xin , Xiaoliang Li , Zhaohong Chen , Fei Chang , Guanghua Guo , Feng Zhu

{"title":"Early coagulation changes as predictors of adverse outcomes in patients with severe burn and inhalation injuries","authors":"Shengyu Huang , Dan Wang , Qimin Ma , Tuo Shen , Dinghong Min , Yusong Wang , Xincheng Liao , Rui Liu , Haiming Xin , Xiaoliang Li , Zhaohong Chen , Fei Chang , Guanghua Guo , Feng Zhu","doi":"10.1016/j.burns.2025.107373","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>Disorders of the coagulation pathway are triggered in patients with severe burn and inhalation injuries in the early stages. There are multiple early coagulation indices identified to correlate with adverse outcomes.</div></div><div><h3>Method</h3><div>A retrospective analysis of patients with severe burn and inhalation injuries from 12 centers in mainland China was performed to identify early changed coagulation indices with predictive value associated with four major 28-day adverse outcomes (death, anticoagulation, mechanical ventilation, continuous renal replacement therapy) by logistic regression. The optimal cut-off value was also determined by Youden's index.</div></div><div><h3>Results</h3><div>A total of 433 patients with severe burn and inhalation injuries were included in the study. Activated partial thromboplastin time (APTT) was found to be a risk factor for death, anticoagulation and continuous renal replacement therapy outcomes, while D-dimer was a risk factor for death and mechanical ventilation outcomes. Compared with previous definitions of coagulopathy, the occurrence of adverse outcomes was well predicted by both APTT and D-dimer. Patients were divided into high-risk and low-risk coagulopathy based on APTT and D-dimer cutoff values, with high-risk coagulopathy being an independent risk factor for death. Age, TBSA, lactate level, and pre-hospital infusion volume were identified as independent influencing factors on high-risk coagulopathy.</div></div><div><h3>Conclusion</h3><div>The coagulation indices APTT and D-dimer in the early post-hospitalization period have a good early warning effect in the severe burn and inhalation injuries population, by which early screening to identify high-risk coagulopathies can be performed and targeted interventions can be implemented.</div></div>","PeriodicalId":50717,"journal":{"name":"Burns","volume":"51 2","pages":"Article 107373"},"PeriodicalIF":3.2000,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Burns","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0305417925000026","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CRITICAL CARE MEDICINE","Score":null,"Total":0}

引用次数: 0

Abstract

Background

Disorders of the coagulation pathway are triggered in patients with severe burn and inhalation injuries in the early stages. There are multiple early coagulation indices identified to correlate with adverse outcomes.

Method

A retrospective analysis of patients with severe burn and inhalation injuries from 12 centers in mainland China was performed to identify early changed coagulation indices with predictive value associated with four major 28-day adverse outcomes (death, anticoagulation, mechanical ventilation, continuous renal replacement therapy) by logistic regression. The optimal cut-off value was also determined by Youden's index.

Results

A total of 433 patients with severe burn and inhalation injuries were included in the study. Activated partial thromboplastin time (APTT) was found to be a risk factor for death, anticoagulation and continuous renal replacement therapy outcomes, while D-dimer was a risk factor for death and mechanical ventilation outcomes. Compared with previous definitions of coagulopathy, the occurrence of adverse outcomes was well predicted by both APTT and D-dimer. Patients were divided into high-risk and low-risk coagulopathy based on APTT and D-dimer cutoff values, with high-risk coagulopathy being an independent risk factor for death. Age, TBSA, lactate level, and pre-hospital infusion volume were identified as independent influencing factors on high-risk coagulopathy.

Conclusion

The coagulation indices APTT and D-dimer in the early post-hospitalization period have a good early warning effect in the severe burn and inhalation injuries population, by which early screening to identify high-risk coagulopathies can be performed and targeted interventions can be implemented.

查看原文本刊更多论文

早期凝血变化作为严重烧伤和吸入性损伤患者不良结局的预测因子。

背景：严重烧伤和吸入性损伤患者早期可触发凝血途径紊乱。有多种早期凝血指标确定与不良后果相关。方法：回顾性分析来自中国大陆12个中心的严重烧伤和吸入性损伤患者，通过logistic回归分析，确定早期改变的凝血指标与4种主要28天不良结局（死亡、抗凝、机械通气、持续肾替代治疗）相关的预测价值。并用约登指数确定最佳临界值。结果：共纳入433例重度烧伤吸入性损伤患者。活化的部分凝血活酶时间（APTT）是死亡、抗凝和持续肾替代治疗结果的危险因素，而d -二聚体是死亡和机械通气结果的危险因素。与以往凝血功能障碍的定义相比，APTT和d -二聚体都能很好地预测不良后果的发生。根据APTT和d -二聚体临界值将患者分为高危凝血功能障碍和低危凝血功能障碍，高危凝血功能障碍是死亡的独立危险因素。年龄、TBSA、乳酸水平和院前输液量被确定为高危凝血病的独立影响因素。结论：重症烧伤吸入性损伤人群住院后早期凝血指标APTT和d -二聚体具有较好的预警作用，可早期筛查凝血高危疾病，实施有针对性的干预。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Burns 医学-皮肤病学

CiteScore

4.50

自引率

18.50%

发文量

304

审稿时长

72 days

期刊介绍： Burns aims to foster the exchange of information among all engaged in preventing and treating the effects of burns. The journal focuses on clinical, scientific and social aspects of these injuries and covers the prevention of the injury, the epidemiology of such injuries and all aspects of treatment including development of new techniques and technologies and verification of existing ones. Regular features include clinical and scientific papers, state of the art reviews and descriptions of burn-care in practice. Topics covered by Burns include: the effects of smoke on man and animals, their tissues and cells; the responses to and treatment of patients and animals with chemical injuries to the skin; the biological and clinical effects of cold injuries; surgical techniques which are, or may be relevant to the treatment of burned patients during the acute or reconstructive phase following injury; well controlled laboratory studies of the effectiveness of anti-microbial agents on infection and new materials on scarring and healing; inflammatory responses to injury, effectiveness of related agents and other compounds used to modify the physiological and cellular responses to the injury; experimental studies of burns and the outcome of burn wound healing; regenerative medicine concerning the skin.