Trauma and thermal injury: comparison of hemostatic and cytokine changes in the acute phase of injury.
BACKGROUND
Initiated either by thermal injury or mechanical trauma, the systemic inflammatory response syndrome stimulates activation of coagulation and fibrinolysis, evolving into a subclinical disseminated intravascular coagulation.


METHODS
Hemostatic parameters, interleukin-6, and endothelin plasma levels were compared in burn and trauma patients. Nineteen patients with major burn injury (> or = 40% total body surface area) were compared with 35 trauma patients with Injury Severity Scores > 25 on day 1 and days 5 to 8.


RESULTS
Thrombin-antithrombin levels were significantly higher in trauma patients than in burn patients (p < 0.0001) on day 1, and endothelin was significantly higher on days 1 and 5 (p < 0.0001) in trauma patients than in burn patients. Interleukin-6 plasminogen activator inhibitor-1, and tissue plasminogen activator levels were elevated above normal limits on both days in both groups.


CONCLUSIONS
There was a difference in the degree and level to which homeostasis was perturbed between the two groups. The mechanism of injury did not affect the initiation of subclinical disseminated intravascular coagulation and cytokine release, and the physiologic response remained the same.
Kowal-Vern
A
A
Department of Pathology, Burn Shock Trauma Institute, Loyola University Medical Center, Maywood, Illinois 60153, USA.
Sharp-Pucci
M M
MM
Walenga
J M
JM
Dries
D J
DJ
Gamelli
R L
RL
D000328:Adult; D001779:Blood Coagulation Factors / Q000032:analysis*; D002056:Burns / Q000097:blood* / Q000145:classification / Q000150:complications / Q000276:immunology; D002059:Burns, Inhalation / Q000097:blood / Q000276:immunology; D016232:Endothelins / Q000097:blood; D005260:Female; D006487:Hemostasis; D006801:Humans; D007239:Infections / Q000209:etiology; D015601:Injury Severity Score; D015850:Interleukin-6 / Q000097:blood*; D008297:Male; D012189:Retrospective Studies; D014947:Wounds and Injuries / Q000097:blood* / Q000145:classification / Q000150:complications / Q000276:immunology
D001779:Blood Coagulation Factors; D016232:Endothelins; D015850:Interleukin-6