Early abnormal fibrinolysis and mortality in patients with thermal injury: a prospective cohort study

BJS open - Tập 5 Số 2 - 2021
Anthony E. Pusateri1, Tuan Le2,1, John W Keyloun3,4, Lauren T. Moffatt5,3, Thomas Orfeo6, Kathleen E. Brummel‐Ziedins3, Melissa M McLawhorn3, Rachael A. Callcut7, Jeffrey W. Shupp8,3,4, Mitchell J. Cohen, Linda Petzold, Jennifer D. Varner, Maria Cristina Bravo3, Kalev Freeman3, K. Mann, Aarti Gautam, Rasha Hammamieh, Marti Jett3
1U.S. Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas, USA
2Department of Epidemiology and Biostatistics, University of Texas Health Science Center , Tyler, Texas, USA
3Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute , Washington, DC, USA
4The Burn Center, Department of Surgery, MedStar Washington Hospital Center, Washington, DC, USA
5Department of Biochemistry, Georgetown University, Washington, DC, USA
6Department of Biochemistry, College of Medicine, University of Vermont , Colchester, Vermont, USA
7Department of Surgery, University of California, Davis, School of Medicine, Sacramento, California, USA
8Department of Surgery, Georgetown University, Washington, DC USA

Tóm tắt

Abstract Introduction Abnormal fibrinolysis early after injury has been associated with increased mortality in trauma patients, but no studies have addressed patients with burn injury. This prospective cohort study aimed to characterize fibrinolytic phenotypes in burn patients and to see if they were associated with mortality. Methods Patients presenting to a regional burn centre within 4 h of thermal injury were included. Blood was collected for sequential viscoelastic measurements using thromboelastography (RapidTEG™) over 12 h. The percentage decrease in clot strength 30 min after the time of maximal clot strength (LY30) was used to categorize patients into hypofibrinolytic/fibrinolytic shutdown (SD), physiological (PHYS) and hyperfibrinolytic (HF) phenotypes. Injury characteristics, demographics and outcomes were compared. Results Of 115 included patients, just over two thirds were male. Overall median age was 40 (i.q.r. 28–57) years and median total body surface area (TBSA) burn was 13 (i.q.r. 6–30) per cent. Some 42 (36.5 per cent) patients had severe burns affecting over 20 per cent TBSA. Overall mortality was 18.3 per cent. At admission 60.0 per cent were PHYS, 30.4 per cent were SD and 9.6 per cent HF. HF was associated with increased risk of mortality on admission (odds ratio 12.61 (95 per cent c.i. 1.12 to 142.57); P = 0.041) but not later during the admission when its incidence also decreased. Admission SD was not associated with mortality, but incidence increased and by 4 h and beyond, SD was associated with increased mortality, compared with PHYS (odds ratio 8.27 (95 per cent c.i. 1.16 to 58.95); P = 0.034). Discussion Early abnormal fibrinolytic function is associated with mortality in burn patients.

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