Characterization of the Endothelial, Coagulofibrinolytic and Inflammatory Profile in Burn Patients after Resuscitation with Fresh Frozen Plasma.

Abstract

Severe burn injuries are associated with endothelial, coagulopathic, and inflammatory dysfunction, requiring resuscitation; this is most often performed with intravenous crystalloids. Colloids, like fresh frozen plasma (FFP), can be used as adjuncts. This prospective observational cohort study investigated whether the varying factor and protein concentrations in a unit of FFP, as well as its allogenic nature, affected the preexisting prothrombotic, fibrinolytic and hyperinflammatory state in burn shock in a group of patients with ≥20% total body surface area (TBSA) who receive transfused plasma as part of the standard of care for resuscitation at a regional burn center. Blood samples were collected immediately prior to administration of the first unit of FFP (Pre-Unit) and immediately after administration of the first unit of FFP (Post-Unit). Concentrations of 31 plasma biomarkers were quantified and compared using paired t-test or a Wilcoxon signed-rank test. Data presented as median (interquartile range). Of the 33 patients included, the median TBSA burn of 34.0% (27.3-45.5). Post-Unit plasma concentrations were decreased compared to Pre-Unit concentrations in factor VIII [329 (201.9-474.1) vs 277 (189.5-438.1) %], fibrinogen [322 (295.3-412.8) vs 305 (285.3-388.5) mg/dL], protein C [105 (96.0-111.5) vs 102 (91.5-112.0) %], total tissue factor pathway inhibitor (TFPI) [69.7 (51.1-96.3) vs 67.7 (50.9-84.5) ng/mL], free TFPI [18.2 (14.2-21.8) vs 16.8 (12.9-21.1) ng/mL], activated/inactivated thrombin-activatable fibrinolysis inhibitor [55.1 (40.7-80.4) vs 48.7 (38.4-64.4) ng/mL], C1 esterase inhibitor [149.6 (132.3-222.1) vs 119.6 (110.4-151.6) %], and TNF-α receptor 1 [2010 (1451-3535) vs 1815 (1418-3189) pg/mL] (p≤0.05). The 23 other biomarkers did not change. While there were small but statistically significant reductions in 8 markers of coagulation, antifibrinolysis and inflammation, the Post-Unit concentrations either remained within or moved closer to the expected reference ranges. After initial transfusion of FFP, there were no clinically significant changes in the preexisting prothrombotic, fibrinolytic, endothelial or inflammatory biological profile.