Early coagulation alterations in intensive care unit burn patients

Introduction

The aim of the present study was to examine the coagulation status of patients in the early postburn period.

Method

Coagulation and fibrinolysis parameters – antithrombin III (ATIII), protein C (PrC), free protein S (PrS), plasminogen activator inhibitor 1 (PAI-1), tissue plasminogen activator (t-PA), thrombin/antithrombin complexes (TAT), plasmin/α₂-antiplasmin complexes (PAP), fibrin degradation products (F1.2) – were measured at ICU admission and daily thereafter for 7 postburn days.

Results

Forty-five patients were screened (nine nonsurvivors and 36 survivors). All patients had a severe deficiency of the coagulation inhibitors on admission. Normalization of these levels in survivors was observed at day 5 for ATIII and PrC, and at day 7 for PrS. All patients had elevated levels of TAT during the investigation period, but survivors had significantly lower levels at day 7 postburn (6.2 ± 4.9 vs 11.4 ± 4.5 μg/l, P < 0.001). PAP levels were within the physiological range in both groups at day 1, remained low in survivors, but raised significantly in nonsurvivors at day 7 (19.3 ± 14 vs 80.9 ± 10.4 μg/l, P = 0.003). The t-PA levels were elevated permanently only in nonsurvivors. PAI-1 levels were increased at day 1 in both groups, but returned to normal values at day 5 in survivors. The degree of PAI-1 activation was significantly higher than this of t-PA. The F1.2 levels were permanently elevated and there was no statistically significant difference in both groups. A logistic regression analysis revealed that ATIII and PrS at days 3, 5 and 7, Pr C at days 5 and 7 and TAT at day 7 were independent predictors of ICU death.

Conclusion

Our findings indicate the early postburn dysregulation of the hemostatic balance characterized by the activation of procoagulant pathways. Although fibrinolysis was activated, the inhibition of fibrinolysis was more pronounced at the same time. The coagulation inhibitors and TAT levels seem to be early predictors of ICU mortality.