title: In-depth analysis of clotting dynamics in burn patients.
abstract: 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.
  
  
  
  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.
  
  
  
  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.
  
  
  
  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.affiliation: Department of Surgery, The Burn Center, MedStar Washington Hospital Center, Washington, DC; Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, DC.
authors.forename: Shawn
authors.initials: S
authors.lastname: Tejiram
authors.affiliation: Department of Biochemistry, University of Vermont, Colchester, Vermont.
authors.forename: Kathleen E
authors.initials: KE
authors.lastname: Brummel-Ziedins
authors.affiliation: Department of Biochemistry, University of Vermont, Colchester, Vermont.
authors.forename: Thomas
authors.initials: T
authors.lastname: Orfeo
authors.affiliation: Biostatistics and Bioinformatics Department, MedStar Health Research Institute, Hyattsville, Maryland.
authors.forename: Mihriye
authors.initials: M
authors.lastname: Mete
authors.affiliation: Biostatistics and Bioinformatics Department, MedStar Health Research Institute, Hyattsville, Maryland.
authors.forename: Sameer
authors.initials: S
authors.lastname: Desale
authors.affiliation: Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, DC.
authors.forename: Brittany N
authors.initials: BN
authors.lastname: Hamilton
authors.affiliation: Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, DC.
authors.forename: Lauren T
authors.initials: LT
authors.lastname: Moffatt
authors.affiliation: Department of Biochemistry, University of Vermont, Colchester, Vermont.
authors.forename: Kenneth G
authors.initials: KG
authors.lastname: Mann
authors.affiliation: Department of Pathology and Laboratory Medicine, University of Vermont, Colchester, Vermont.
authors.forename: Russell P
authors.initials: RP
authors.lastname: Tracy
authors.affiliation: 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.
authors.forename: Jeffrey W
authors.initials: JW
authors.lastname: Shupp
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D001777:Blood Coagulation; D001778:Blood Coagulation Disorders / Q000097:blood / Q000175:diagnosis / Q000209:etiology*; D001780:Blood Coagulation Tests; D002056:Burns / Q000097:blood / Q000150:complications* / Q000401:mortality; D003199:Computer Systems; D016207:Cytokines / Q000097:blood; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012307:Risk Factors
chemical_list: D015415:Biomarkers; D016207:Cytokines
keywords: Burn injury; Clotting factor; Coagulopathy; INR; Thermal injury