1
|
Kazemzadeh J, Pakzad S, Parizad N, Jafari Y. Skin graft surgery and its impact on platelet counts in Iranian burn patients: a non-randomized clinical trial. BMC Surg 2024; 24:200. [PMID: 38956520 PMCID: PMC11220946 DOI: 10.1186/s12893-024-02489-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 06/21/2024] [Indexed: 07/04/2024] Open
Abstract
BACKGROUND Platelets are critical in maintaining homeostasis and immune response in burn patients. The concentration of platelets decreases in burn patients, and any intervention that increases serum platelet concentration can prevent serious consequences and patient death. The present study aimed to assess the impact of skin graft surgery on burn patients' platelet counts. METHODS In this non-randomized clinical trial, 200 burn patients were investigated. The patients were recruited from the surgical ward of Imam Khomeini Teaching Hospital during the first six months of 2021. After completing the checklist, patients underwent skin graft surgery. Blood was taken from the patients during surgery in the operating room and on the third and fifth day after the surgery to check platelets. Data analysis was conducted using SPSS software (ver. 22.0). RESULTS Most patients (63.5%) were male, and 73 (36.5%) were female. One hundred eighty-one patients (90.5%) had deep burns, and 19 (9.5%) had superficial burns. The mean burns percentage in the patients was 19.3 ± 15.4%, the lowest was 2%, and the highest was 90%. The most common burns were caused by flame (42%) and boiling water (30.5%). The patients' outcomes revealed that 6% gained complete recovery, 86.5% partial recovery, 2.5% showed transplant rejection, and 5% died. Mean platelet levels in deceased patients had an upward trend. The mean platelet counts of patients were elevated during surgery (289,855 ± 165,378), decreased three days after surgery (282,778 ± 317,310), and elevated again five days after surgery (330,375 ± 208,571). However, no significant difference was found between the mean platelet counts during surgery, the third and fifth days after surgery in patients undergoing skin grafts (P = 0.057). CONCLUSIONS This study suggests that skin graft positively increases the patient's platelets. Further studies are needed to confirm the findings and elucidate the mechanism. Iranian Registry of Clinical Trial approval code (IRCT# IRCT20131112015390N8 & 06/01/2024).
Collapse
Affiliation(s)
- Jafar Kazemzadeh
- Reconstructive and Burn Surgery Department, Urmia University of Medical Sciences, Urmia, Iran
| | - Shiva Pakzad
- Reconstructive and Burn Surgery Department, Urmia University of Medical Sciences, Urmia, Iran
| | - Naser Parizad
- Childhood Obesity Research Center, Urmia University of Medical Sciences, Urmia, Iran.
- Nursing and Midwifery Faculty, Campus Nazlu, 11 KM Road Seru, Urmia, 575611-5111, West Azerbaijan, Iran.
| | - Yashar Jafari
- Department of General surgery, Urmia University of Medical Sciences, Urmia, Iran
| |
Collapse
|
2
|
Çinar MA, Erkiliç A. Effect of aerobic exercise on neutrophil-lymphocyte ratio, platelet-lymphocyte ratio, and lymphocyte-monocyte ratio in burn patients: A randomized controlled trial. J Plast Reconstr Aesthet Surg 2024; 95:199-206. [PMID: 38936330 DOI: 10.1016/j.bjps.2024.05.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 05/08/2024] [Accepted: 05/24/2024] [Indexed: 06/29/2024]
Abstract
BACKGROUND This study aimed to investigate the effects of aerobic exercises in addition to standard treatment on parameters such as neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and lymphocyte-monocyte ratio (LMR) in patients with burns. METHODS A total of 31 hospitalized patients included in the study were divided into two groups using covariate adaptive randomization method according to burn percentage and burn type (1st:standard treatment, 2nd: standard treatment + aerobic training). NLR, PLR, and LMR were evaluated for 5 weeks in all groups. Independent samples t-test and Mann-Whitney U test were used to examine differences between the two groups. For comparing more than two groups, Friedman's test was used for non-normally distributed variables and Bonferroni test was used as the post hoc pairwise comparison method. RESULTS Intragroup comparison of individuals in group 1 showed that the NLR values on days 7 and 14 were significantly higher than those on days 28 and 35 (p < 0.05). Intragroup comparison of individuals in group 2 showed that the NLR values on days 1, 7, and 14 were significantly higher than those on days 21 and 35. Additionally, the NLR values on day 14 were higher than those on day 28. Individuals in group 1 showed a significant increase in PLR values each week (p < 0.05). CONCLUSIONS The addition of aerobic training to standard treatment in patients with burns may be more effective in improving inflammation markers such as NLR, PLR, and LMR.
Collapse
Affiliation(s)
- Murat Ali Çinar
- Hasan Kalyoncu University, Faculty of Health Science, Department of Physiotherapy and Rehabilitation, Gaziantep, Turkey.
| | - Ahmet Erkiliç
- Gaziantep City Hospital, Burn Center, General Surgery, Gaziantep, Turkey
| |
Collapse
|
3
|
Liu P, Li XJ, Zhang T, Huang YH. Comparison between XGboost model and logistic regression model for predicting sepsis after extremely severe burns. J Int Med Res 2024; 52:3000605241247696. [PMID: 38698505 PMCID: PMC11067675 DOI: 10.1177/03000605241247696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 03/28/2024] [Indexed: 05/05/2024] Open
Abstract
OBJECTIVE To compare an Extreme Gradient Boosting (XGboost) model with a multivariable logistic regression (LR) model for their ability to predict sepsis after extremely severe burns. METHODS For this observational study, patient demographic and clinical information were collected from medical records. The two models were evaluated using area under curve (AUC) of the receiver operating characteristic (ROC) curve. RESULTS Of the 103 eligible patients with extremely severe burns, 20 (19%) were in the sepsis group, and 83 (81%) in the non-sepsis group. The LR model showed that age, admission time, body index (BI), fibrinogen, and neutrophil to lymphocyte ratio (NLR) were risk factors for sepsis. Comparing AUC of the ROC curves, the XGboost model had a higher predictive performance (0.91) than the LR model (0.88). The SHAP visualization tool indicated fibrinogen, NLR, BI, and age were important features of sepsis in patients with extremely severe burns. CONCLUSIONS The XGboost model was superior to the LR model in predictive efficacy. Results suggest that, fibrinogen, NLR, BI, and age were correlated with sepsis after extremely severe burns.
Collapse
Affiliation(s)
- Peng Liu
- Department of Burn and Plastic, Guangzhou Red Cross Hospital, Medical College, Jinan University, Guangzhou, China
| | - Xiao-Jian Li
- Department of Burn and Plastic, Guangzhou Red Cross Hospital, Medical College, Jinan University, Guangzhou, China
| | - Tao Zhang
- Department of Burn and Plastic, Guangzhou Red Cross Hospital, Medical College, Jinan University, Guangzhou, China
| | - Yi-Hui Huang
- Department of Pediatric Medicine, Guangzhou Red Cross Hospital, Medical College, Jinan University, Guangzhou, China
| |
Collapse
|
4
|
Schaller C, Petitpierre A, von Felten S, Rittirsch D, Kim BS, Giovanoli P, Grünherz L, Lindenblatt N. Thromboembolic events in burn patients: An analysis of risk factors and different anticoagulants. Burns 2024; 50:569-577. [PMID: 38216375 DOI: 10.1016/j.burns.2023.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 10/20/2023] [Accepted: 12/25/2023] [Indexed: 01/14/2024]
Abstract
BACKGROUND Burn patients are in a state of activated coagulation, putting them at risk for thromboembolic events. Additionally, certain patient-related factors are associated with an increased risk of thrombus formation. This study aimed to evaluate the incidence of thromboembolic events and identify potential risk factors, including patient characteristics, surgical treatment, anticoagulation strategies, and laboratory parameters. METHODS A single-centre retrospective cohort study was conducted on all patients with burns treated between 2002 and 2020. Medical reports of patients with and without thromboembolic events were descriptively analysed. The association of time to thromboembolic events with total body surface area (TBSA) was assessed by cause-specific Cox models adjusted for different covariates. The association of time to thromboembolic events with type and dosage of anticoagulants was assessed using a cause-specific Cox proportional hazards model with time-dependent covariates, applied to a matched subset of patients. RESULTS The incidence of thromboembolic events was 8.1% in a cohort of 642 patients. We found a statistically significant increase in the hazard for thromboembolic events by a factor of 1.02 (95% CI 1.00 to 1.03; P ≤ 0.05) per percent increase in TBSA. We identified former alcohol abuse (HR=2.54, CI 1.33 to 4.84, P = 0.005) and higher body mass index (HR=1.06, 95% CI 1.00 to 1.12, P = 0.046) as potential risk factors for the development of thromboembolic events. We further noted inadequate median anti-Factor-X activity levels and elevated C-reactive protein and procalcitonin levels at the time of the event. CONCLUSION Our results showed a moderate risk of thromboembolic events among burn patients, underlining the importance of close monitoring with regard to thrombus formation. In particular, patients with higher TBSA, alcohol abuse and BMI may be evaluated more regularly for thromboembolic events. Anti-Factor-X activity levels should be determined regularly and therapy should be adjusted if necessary.
Collapse
Affiliation(s)
- Claudine Schaller
- Department of Plastic Surgery and Hand Surgery, University Hospital Zürich, Switzerland
| | - Anouk Petitpierre
- Master Program in Biostatistics, University of Zurich, Zurich, Switzerland
| | - Stefanie von Felten
- Epidemiology, Biostatistics and Prevention Institute, Department of Biostatistics, University of Zurich, Switzerland
| | - Daniel Rittirsch
- Department of Plastic Surgery and Hand Surgery, University Hospital Zürich, Switzerland
| | - Bong-Sung Kim
- Department of Plastic Surgery and Hand Surgery, University Hospital Zürich, Switzerland
| | - Pietro Giovanoli
- Department of Plastic Surgery and Hand Surgery, University Hospital Zürich, Switzerland
| | - Lisanne Grünherz
- Department of Plastic Surgery and Hand Surgery, University Hospital Zürich, Switzerland
| | - Nicole Lindenblatt
- Department of Plastic Surgery and Hand Surgery, University Hospital Zürich, Switzerland.
| |
Collapse
|
5
|
Yoon J, Kym D, Hur J, Park J, Kim M, Cho YS, Chun W, Yoon D. The clinical differentiation of blood culture-positive and -negative sepsis in burn patients: a retrospective cohort study. BURNS & TRAUMA 2023; 11:tkad031. [PMID: 38116468 PMCID: PMC10729782 DOI: 10.1093/burnst/tkad031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 04/29/2023] [Indexed: 12/21/2023]
Abstract
Background Sepsis is a potentially life-threatening condition that occurs when the body's response to infection leads to widespread inflammation and tissue damage. Negative cultures can make it difficult for clinicians to make a diagnosis and may raise questions about the validity of the definition of sepsis. In addition, the clinical distinctions between burn patients with blood culture-positive and -negative sepsis are also poorly understood. Therefore, this study aimed to examine the clinical differences between blood culture-positive and -negative sepsis in burn patients in order to improve the understanding of the pathophysiology and epidemiology of sepsis in this population. Methods This study had a retrospective design, and the participants were adults aged ≥18 years. Patients diagnosed with sepsis were divided into two groups based on their blood culture results within 1 week of sepsis diagnosis. Results We enrolled 1643 patients admitted to our institution's burn intensive care unit between January 2010 and December 2021. pH, platelet count, bicarbonate and haematocrit were significant in both the positive and negative groups. However, lymphocyte, red cell distribution width and blood urea nitrogen were significant only in the positive group, whereas lactate dehydrogenase was significant only in the negative group. Acinetobacter baumannii, Pseudomonas aeruginosa, and Klebsiella pneumonia are common gram-negative bacterial species, and Staphylococcus aureus and Staphylococcus epidermidis are common gram-positive bacterial species seen in burn patients with positive blood cultures. Carbapenem resistance was found to be associated with an unfavourable prognosis in gram-negative bacteria, with the exception of P. aeruginosa. Conclusions pH, platelet count, bicarbonate and haematocrit were routine biomarkers that demonstrated statistical significance in both groups. Lactate dehydrogenase was significant in the blood-negative group, while red cell distribution width, blood urea nitrogen and lymphocyte count were significant in the positive group. Furthermore, the most common causes of sepsis are gram-negative bacteria, including A. baumannii, K. pneumoniae and P. aeruginosa. Additionally, resistance to carbapenems is associated with unfavourable outcomes.
Collapse
Affiliation(s)
- Jaechul Yoon
- Department of Surgery and Critical Care, Burn Center, Hangang Sacred Heart Hospital, Hallym University Medical Center, 12, Beodeunaru-ro 7-gil, Youngdeungpo-gu, Seoul 07247, Korea
- Graduate school of Medicine, Kanwon National University, 1, Kangwondaehak-gil, Chuncheon-si, Gangwon-do, Republic of Korea
- Burn Institutes, Hangang Sacred Heart Hospital, Hallym University Medical Center, 12, Beodeunaru-ro 7-gil, Youngdeungpo-gu, Seoul 07247, Korea
| | - Dohern Kym
- Department of Surgery and Critical Care, Burn Center, Hangang Sacred Heart Hospital, Hallym University Medical Center, 12, Beodeunaru-ro 7-gil, Youngdeungpo-gu, Seoul 07247, Korea
- Burn Institutes, Hangang Sacred Heart Hospital, Hallym University Medical Center, 12, Beodeunaru-ro 7-gil, Youngdeungpo-gu, Seoul 07247, Korea
| | - Jun Hur
- Department of Surgery and Critical Care, Burn Center, Hangang Sacred Heart Hospital, Hallym University Medical Center, 12, Beodeunaru-ro 7-gil, Youngdeungpo-gu, Seoul 07247, Korea
- Burn Institutes, Hangang Sacred Heart Hospital, Hallym University Medical Center, 12, Beodeunaru-ro 7-gil, Youngdeungpo-gu, Seoul 07247, Korea
| | - Jongsoo Park
- Department of Surgery and Critical Care, Burn Center, Hangang Sacred Heart Hospital, Hallym University Medical Center, 12, Beodeunaru-ro 7-gil, Youngdeungpo-gu, Seoul 07247, Korea
- Burn Institutes, Hangang Sacred Heart Hospital, Hallym University Medical Center, 12, Beodeunaru-ro 7-gil, Youngdeungpo-gu, Seoul 07247, Korea
| | - Myongjin Kim
- Department of Surgery and Critical Care, Burn Center, Hangang Sacred Heart Hospital, Hallym University Medical Center, 12, Beodeunaru-ro 7-gil, Youngdeungpo-gu, Seoul 07247, Korea
- Burn Institutes, Hangang Sacred Heart Hospital, Hallym University Medical Center, 12, Beodeunaru-ro 7-gil, Youngdeungpo-gu, Seoul 07247, Korea
| | - Yong Suk Cho
- Department of Surgery and Critical Care, Burn Center, Hangang Sacred Heart Hospital, Hallym University Medical Center, 12, Beodeunaru-ro 7-gil, Youngdeungpo-gu, Seoul 07247, Korea
- Burn Institutes, Hangang Sacred Heart Hospital, Hallym University Medical Center, 12, Beodeunaru-ro 7-gil, Youngdeungpo-gu, Seoul 07247, Korea
| | - Wook Chun
- Department of Surgery and Critical Care, Burn Center, Hangang Sacred Heart Hospital, Hallym University Medical Center, 12, Beodeunaru-ro 7-gil, Youngdeungpo-gu, Seoul 07247, Korea
- Burn Institutes, Hangang Sacred Heart Hospital, Hallym University Medical Center, 12, Beodeunaru-ro 7-gil, Youngdeungpo-gu, Seoul 07247, Korea
| | - Dogeon Yoon
- Burn Institutes, Hangang Sacred Heart Hospital, Hallym University Medical Center, 12, Beodeunaru-ro 7-gil, Youngdeungpo-gu, Seoul 07247, Korea
| |
Collapse
|
6
|
Ding X, Wang Y, Ma W, Peng Y, Huang J, Wang M, Zhu H. Development of early prediction model of in-hospital cardiac arrest based on laboratory parameters. Biomed Eng Online 2023; 22:116. [PMID: 38057823 DOI: 10.1186/s12938-023-01178-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 11/23/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND In-hospital cardiac arrest (IHCA) is an acute disease with a high fatality rate that burdens individuals, society, and the economy. This study aimed to develop a machine learning (ML) model using routine laboratory parameters to predict the risk of IHCA in rescue-treated patients. METHODS This retrospective cohort study examined all rescue-treated patients hospitalized at the First Medical Center of the PLA General Hospital in Beijing, China, from January 2016 to December 2020. Five machine learning algorithms, including support vector machine, random forest, extra trees classifier (ETC), decision tree, and logistic regression algorithms, were trained to develop models for predicting IHCA. We included blood counts, biochemical markers, and coagulation markers in the model development. We validated model performance using fivefold cross-validation and used the SHapley Additive exPlanation (SHAP) for model interpretation. RESULTS A total of 11,308 participants were included in the study, of which 7779 patients remained. Among these patients, 1796 (23.09%) cases of IHCA occurred. Among five machine learning models for predicting IHCA, the ETC algorithm exhibited better performance, with an AUC of 0.920, compared with the other four machine learning models in the fivefold cross-validation. The SHAP showed that the top ten factors accounting for cardiac arrest in rescue-treated patients are prothrombin activity, platelets, hemoglobin, N-terminal pro-brain natriuretic peptide, neutrophils, prothrombin time, serum albumin, sodium, activated partial thromboplastin time, and potassium. CONCLUSIONS We developed a reliable machine learning-derived model that integrates readily available laboratory parameters to predict IHCA in patients treated with rescue therapy.
Collapse
Affiliation(s)
- Xinhuan Ding
- Medical School of Chinese PLA, Beijing, 100853, China
- Department of Emergency, The First Medical Center, Chinese PLA General Hospital, Fuxing Road 28, Beijing, 100853, People's Republic of China
| | - Yingchan Wang
- Department of Emergency, The First Medical Center, Chinese PLA General Hospital, Fuxing Road 28, Beijing, 100853, People's Republic of China
| | - Weiyi Ma
- Medical School of Chinese PLA, Beijing, 100853, China
- Department of Emergency, The First Medical Center, Chinese PLA General Hospital, Fuxing Road 28, Beijing, 100853, People's Republic of China
| | - Yaojun Peng
- Medical School of Chinese PLA, Beijing, 100853, China
- Department of Emergency, The First Medical Center, Chinese PLA General Hospital, Fuxing Road 28, Beijing, 100853, People's Republic of China
| | - Jingjing Huang
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510000, Guangdong, China
- Department of Emergency, Hainan Hospital of PLA General Hospital, Sanya, 572013, Hainan, China
| | - Meng Wang
- Medical School of Chinese PLA, Beijing, 100853, China
- Department of Emergency, The First Medical Center, Chinese PLA General Hospital, Fuxing Road 28, Beijing, 100853, People's Republic of China
| | - Haiyan Zhu
- Medical School of Chinese PLA, Beijing, 100853, China.
- Department of Emergency, The First Medical Center, Chinese PLA General Hospital, Fuxing Road 28, Beijing, 100853, People's Republic of China.
| |
Collapse
|
7
|
Jian F, Lu C, Jia H, Na L, Peng Y, Maohong B, Xulin C. Characteristics of blood clotting on thromboelastography in patients with early burns. Transfus Apher Sci 2023; 62:103824. [PMID: 37813753 DOI: 10.1016/j.transci.2023.103824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 09/12/2023] [Accepted: 09/22/2023] [Indexed: 10/11/2023]
Abstract
BACKGROUND Thromboelastography (TEG) is a viscoelastic test that may be used to evaluate the hemostatic function of whole blood, and it may be useful for burn patients with multiple hemostatic defects. METHODS We retrospectively recruited patients with burns between January 2019 and July 2021. Blood samples were drawn on admission and subjected to coagulation parameter assessment, including conventional coagulation tests and TEG assessment. Receiver operating characteristic (ROC) analysis was performed to predict the occurrence of complications in patients with early burns. RESULTS Ninety-three patients with early burns met the inclusion criteria. Patients with minor, moderate, severe, and extremely severe burns accounted for 19.4 %, 36.6 %, 16.1 %, and 27.9 % of all patients, respectively. Compared with the healthy controls, patients with early burns showed significant reductions in the R and K values, and significant elevation in the maximum amplitude (MA), coagulation index (CI), and alpha angle. Compared with minor and moderate burn patients, patients with severe and extremely severe burns had lower K values and thrombin time and higher alpha angle, CI, prothrombin time, international normalized ratio, D-dimer, and fibrin degradation products. Patients with hypercoagulation had lower R and K values, longer MA, longer CI, and greater alpha angle. After ROC analysis, the areas under the ROC curve for acute lung injury, acute kidney injury, and bleeding were 0.789, 0.802, and 0.900, respectively. CONCLUSION TEG provides insight into the hemostatic state of patients with early burns, and can predict complications in early burn patients when combined with conventional coagulation tests.
Collapse
Affiliation(s)
- Fang Jian
- Department of Blood Transfusion, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230001, China
| | - Chen Lu
- Department of Burns, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230001, China
| | - He Jia
- Department of Burns, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230001, China
| | - Li Na
- Department of Blood Transfusion, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230001, China
| | - Yang Peng
- Department of Blood Transfusion, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230001, China
| | - Bian Maohong
- Department of Blood Transfusion, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230001, China.
| | - Chen Xulin
- Department of Burns, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230001, China.
| |
Collapse
|
8
|
Chen SL, Liu XY, Huang JH, Xian LH, Li XS, Wang KR, Li J, Zhang TC, Huang GG, Liu XQ, Zeng HK, Zhou MH, Jiang WQ. The expression of CD86 in CD3 +CD56 + NKT cells is associated with the occurrence and prognosis of sepsis-associated encephalopathy in sepsis patients: a prospective observational cohort study. Immunol Res 2023; 71:929-940. [PMID: 37405561 DOI: 10.1007/s12026-023-09405-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 06/27/2023] [Indexed: 07/06/2023]
Abstract
The role of CD3+CD56+ natural killer T (NKT) cells and its co-signaling molecules in patients with sepsis-associated encephalopathy (SAE) is unknown. In this prospective observational cohort study, we initially recruited 260 septic patients and eventually analyzed 90 patients, of whom 57 were in the SAE group and 37 were in the non-SAE group. Compared to the non-SAE group, 28-day mortality was significantly increased in the SAE group (33.3% vs. 12.1%, p = 0.026), while the mean fluorescence intensity (MFI) of CD86 in CD3+CD56+ NKT cells was significantly lower (2065.8 (1625.5 ~ 3198.8) vs. 3117.8 (2278.1 ~ 5349), p = 0.007). Multivariate analysis showed that MFI of CD86 in NKT cells, APACHE II score, and serum albumin were independent risk factors for SAE. Furthermore, the Kaplan-Meier survival analysis indicated that the mortality rate was significantly higher in the high-risk group than in the low-risk group (χ2 = 14.779, p < 0.001). This study showed that the decreased expression of CD86 in CD3+CD56+ NKT cells is an independent risk factor of SAE; thus, a prediction model including MFI of CD86 in NKT cells, APACHE II score, and serum albumin can be constructed for diagnosing SAE and predicting prognosis.
Collapse
Affiliation(s)
- Sheng-Long Chen
- Department of Emergency&Department of Critical Care Medicine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, 106 Zhongshan Er Road, Guangzhou, 510080, Guangdong, China
- Medical College, Shantou University, Shantou, 515041, Guangdong, China
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, 510080, Guangdong, China
- The Second School of Clinical Medicine, Southern Medical University, 1063 Shatai Nan Road, Guangzhou, 510515, China
| | - Xiao-Yu Liu
- Department of Emergency&Department of Critical Care Medicine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, 106 Zhongshan Er Road, Guangzhou, 510080, Guangdong, China
| | - Jun-Hong Huang
- Department of Emergency&Department of Critical Care Medicine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, 106 Zhongshan Er Road, Guangzhou, 510080, Guangdong, China
- School of Medicine, South China University of Technology, Guangzhou, 510006, China
| | - Lu-Hua Xian
- Laboratory Medicine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, 106 Zhongshan Er Road, Guangzhou, 510080, Guangdong, China
| | - Xu-Sheng Li
- Department of Emergency&Department of Critical Care Medicine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, 106 Zhongshan Er Road, Guangzhou, 510080, Guangdong, China
| | - Kang-Rong Wang
- Department of Critical Care Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Jing Li
- Department of Emergency&Department of Critical Care Medicine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, 106 Zhongshan Er Road, Guangzhou, 510080, Guangdong, China
- The Second School of Clinical Medicine, Southern Medical University, 1063 Shatai Nan Road, Guangzhou, 510515, China
| | - Tian-Cao Zhang
- Department of Emergency&Department of Critical Care Medicine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, 106 Zhongshan Er Road, Guangzhou, 510080, Guangdong, China
- Medical College, Shantou University, Shantou, 515041, Guangdong, China
| | - Guo-Ge Huang
- Department of Emergency&Department of Critical Care Medicine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, 106 Zhongshan Er Road, Guangzhou, 510080, Guangdong, China
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, 510080, Guangdong, China
| | - Xin-Qiang Liu
- Department of Emergency&Department of Critical Care Medicine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, 106 Zhongshan Er Road, Guangzhou, 510080, Guangdong, China
| | - Hong-Ke Zeng
- Department of Emergency&Department of Critical Care Medicine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, 106 Zhongshan Er Road, Guangzhou, 510080, Guangdong, China
| | - Mao-Hua Zhou
- Laboratory Medicine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, 106 Zhongshan Er Road, Guangzhou, 510080, Guangdong, China.
| | - Wen-Qiang Jiang
- Department of Emergency&Department of Critical Care Medicine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, 106 Zhongshan Er Road, Guangzhou, 510080, Guangdong, China.
- Medical College, Shantou University, Shantou, 515041, Guangdong, China.
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, 510080, Guangdong, China.
- The Second School of Clinical Medicine, Southern Medical University, 1063 Shatai Nan Road, Guangzhou, 510515, China.
- School of Medicine, South China University of Technology, Guangzhou, 510006, China.
| |
Collapse
|
9
|
Jiang M, Zhang Q, Zhang C, Li Z, Li Q, Qu X, Zhang Y, Hu K. Evaluation of Platelet Distribution Width as an Early Predictor of Acute Kidney Injury in Extensive Burn Patients. Emerg Med Int 2023; 2023:6694313. [PMID: 37720549 PMCID: PMC10501840 DOI: 10.1155/2023/6694313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 08/13/2023] [Accepted: 08/16/2023] [Indexed: 09/19/2023] Open
Abstract
Background The extensive burns devastate trauma. The research was designed to analyse the predictive value of early platelet (PLT) indices on the development of acute kidney injury (AKI) after severe burns. Methods and Results 186 patients with extensive burns (burn area ≥30%) were eventually involved. Multivariate analyses pointed out that platelet distribution width (PDW) in the first 24 h after admission was an independent risk factor for AKI, severe AKI, and RRT requirement in patients with severe burns, and AKI risk showed an increase of 30.9% per increase of 1% in PDW (OR = 1.309, CI, 1.075-1.594, and P = 0.007). It was found that the area under the ROC curve (AUC) of PDW predicting AKI was 0.735 and that the AUC value was 0.81 for AKI after combining PDW and blood urea nitrogen (BUN). Based on the cut-off value PDW = 17.7%, patients were divided into high- (PDW ≥17.7%) and low-risk (PDW <17.7%) groups. In the KM analysis, there was a higher cumulative incidence of AKI if patients were in a high-risk group (in 30 days); and the stages of AKI showed a linear upward trend (chi-square test for linear trend P < 0.001) as there was an increase in the risk level. Conclusion The PDW level in the early stage serves as an important risk factor for AKI, severe AKI, and RRT requirement in extensive burns. When PDW >17.7%, burn patients are not only at a higher risk for AKI but may also have higher AKI severity. Due to low cost and wide availability, PDW has the potential to be the tool that can predict AKI in extensive burn patients.
Collapse
Affiliation(s)
- Ming Jiang
- Department of Burn and Plastic Surgery, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
- Nantong University Medical School, Nantong, Jiangsu, China
| | - Qingrong Zhang
- Third Military Medical University (Army Medical University), Chongqing, China
| | - Chuwei Zhang
- Department of Burn and Plastic Surgery, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
- Nantong University Medical School, Nantong, Jiangsu, China
| | - Zihan Li
- Department of Burn and Plastic Surgery, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
- Nantong University Medical School, Nantong, Jiangsu, China
| | - Qiqi Li
- Department of Burn and Plastic Surgery, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
- Nantong University Medical School, Nantong, Jiangsu, China
| | - Xun Qu
- Department of Burn and Plastic Surgery, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
| | - Yi Zhang
- Department of Burn and Plastic Surgery, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
| | - Kesu Hu
- Department of Burn and Plastic Surgery, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
| |
Collapse
|
10
|
Jiang M, Qian H, Li Q, Han Y, Hu K. Predictive value of lactate dehydrogenase combined with the abbreviated burn severity index for acute kidney injury and mortality in severe burn patients. Burns 2023; 49:1344-1355. [PMID: 36805837 DOI: 10.1016/j.burns.2023.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 12/15/2022] [Accepted: 01/25/2023] [Indexed: 02/01/2023]
Abstract
BACKGROUND Extensive burns are devastating trauma. This study aimed to explore the predictive value of early lactate dehydrogenase (LDH) level, the abbreviated burn severity index (ABSI) and their combination on acute kidney injury (AKI) and mortality after severe burns. METHODS AND RESULTS 194 severe burn patients (TBSA ≥ 30%) were included. After multivariate analyses, early LDH value (first 24 h after admission) was an independent risk factor for early AKI (OR=1.095, CI,1.025-1.169,p = 0.007) and AKI (OR=1.452, CI,1.131-1.864, p = 0.003) in severe burn patients and was still a significant risk factor for mortality (OR=1.059, CI,1.006-1.115,p = 0.03). In ROC analysis, after combining LDH and ABSI, the AUC values were 0.925 for AKI, 0.926 for stage 3 AKI, and 0.904 for mortality. Based on cut-off values, patients were divided into different risk groups. The cumulative incidence of AKI (within 5 days, 30 days) and survival rate (within 60 days) were analyzed by the Kaplan-Meier method. The mortality, AKI incidence, and AKI staging showed a significant upward trend with the increasing risk level (P < 0.001). CONCLUSION Early LDH level is an independent risk factor for early AKI and AKI. LDH combined with ABSI can better predict mortality and AKI than single indicators.
Collapse
Affiliation(s)
- Ming Jiang
- Department of Burn and Plastic Surgery, Affiliated Hospital of Nantong University, Nantong, Jiangsu Province 226001, People's Republic of China; Nantong University Medical School, Nantong, Jiangsu Province 226001, People's Republic of China.
| | - Hongyan Qian
- Cancer Research Centre Nantong, Tumor Hospital Affiliated to Nantong University, Nantong, Jiangsu Province 226300, People's Republic of China.
| | - Qiqi Li
- Department of Burn and Plastic Surgery, Affiliated Hospital of Nantong University, Nantong, Jiangsu Province 226001, People's Republic of China; Nantong University Medical School, Nantong, Jiangsu Province 226001, People's Republic of China.
| | - Yingying Han
- Nantong Center for Disease Control and Prevention Institute of Chronic Non-communicable Diseases Prevention and Control, Nantong, Jiangsu Province 226001, People's Republic of China.
| | - Kesu Hu
- Department of Burn and Plastic Surgery, Affiliated Hospital of Nantong University, Nantong, Jiangsu Province 226001, People's Republic of China.
| |
Collapse
|
11
|
Yoon J, Kym D, Hur J, Cho YS, Chun W, Yoon D. Longitudinal profile of routine biomarkers for mortality prediction using unsupervised clustering algorithm in severely burned patients: a retrospective cohort study with prospectively collected data. Ann Surg Treat Res 2023; 104:126-135. [PMID: 36816736 PMCID: PMC9929432 DOI: 10.4174/astr.2023.104.2.126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 01/09/2023] [Accepted: 01/10/2023] [Indexed: 02/10/2023] Open
Abstract
Purpose Burn injury has high clinical heterogeneity and worse prognosis in severely burned patients. Clustering algorithms using unsupervised methods to identify groups with similar trajectories in heterogeneous disease patients can provide insight into mechanisms of disease pathogenesis. This study analyzed routinely collected biomarkers to evaluate mortality prediction, find clinical meanings for these or their subtypes, and evaluate patterns. Methods This retrospective cohort study included patients aged >18 years, between July 2012 and June 2021. All eligible patients received fluid resuscitation and survived for at least 7 days. Characteristics of clinical interest to the physician at 4 clinically important time points were evaluated. Results Eligible patients were divided into 4 subgroups according to these time points: from 1st week to 4th week. Total of 1,249 patients admitted within 2 days after burns and receiving fluid resuscitation were included. Mean Harrell's C-index of pH was the highest (0.816), followed by platelets (0.807), creatinine (0.796), red cell distribution width (RDW, 0.778), and lactate (0.759). Longitudinal profiles among biomarkers were different. Conclusion The main predictors were pH, platelets, creatinine, RDW, and lactate. Creatinine and RDW showed consistent patterns. The other markers varied according to patient condition. Thus, these markers could provide clues into underlying mechanisms and predict mortality.
Collapse
Affiliation(s)
- Jaechul Yoon
- Department of Surgery and Critical Care, Burn Center, Hangang Sacred Heart Hospital, Hallym University Medical Center, Seoul, Korea
| | - Dohern Kym
- Department of Surgery and Critical Care, Burn Center, Hangang Sacred Heart Hospital, Hallym University Medical Center, Seoul, Korea.,Burn Institutes, Hangang Sacred Heart Hospital, Hallym University Medical Center, Seoul, Korea
| | - Jun Hur
- Department of Surgery and Critical Care, Burn Center, Hangang Sacred Heart Hospital, Hallym University Medical Center, Seoul, Korea
| | - Yong-Suk Cho
- Department of Surgery and Critical Care, Burn Center, Hangang Sacred Heart Hospital, Hallym University Medical Center, Seoul, Korea
| | - Wook Chun
- Department of Surgery and Critical Care, Burn Center, Hangang Sacred Heart Hospital, Hallym University Medical Center, Seoul, Korea.,Burn Institutes, Hangang Sacred Heart Hospital, Hallym University Medical Center, Seoul, Korea
| | - Dogeon Yoon
- Burn Institutes, Hangang Sacred Heart Hospital, Hallym University Medical Center, Seoul, Korea
| |
Collapse
|
12
|
Li Q, Zhang T, Wang L, Li F, Chen Q, Cao S, Ba T. Clinical significance of R-TEG in severe burn patients with coagulation dysfunction. Injury 2022; 53:3993-3999. [PMID: 36210205 DOI: 10.1016/j.injury.2022.09.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 08/27/2022] [Accepted: 09/29/2022] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The aim of this study was to retrospectively analyze Thrombelastography (TEG) data of severe burn patients to provide a clinical basis for timely diagnosis and treatment of coagulation dysfunction. METHODS The present study comprised burn patients with full thickness TBSA ≥ 60%. The patients included in the study were admitted to the Third Affiliated Hospital of Inner Mongolia Medical University between March 2019 and March 2022 and died within 10 days. Patient demographic and clinical data, including abbreviated burn severity index (ABSI) score, full thickness and overall total surface burn area (TBSA), injury cause, International Society on Thrombosis and Hemostasis (ISTH) score, were retrieved from the electronic medical record system. TEG data (including ACT, K, α, MA and LY30), platelet count (PLT), mean platelet volume (MPV) and platelet distribution width (PDW) data were obtained from the records of included patients for analysis. RESULTS A total of 9 patients were enrolled. The average burn area was 90.0% TBSA and the full-thickness TBSA was 72.0%. The results showed that α, MA and PLT count values were significantly lower relative to those at obtained throughout admission period (all p < 0.05). PDW and MPV were significantly higher compared with the values at admission (all p < 0.05). ACT time was significantly longer from day 2 after severe burn compared with the ACT time at admission (all p < 0.05). LY30 value from day 3 after severe burn was significantly higher compared with the value at admission (p < 0.05). One patient was diagnosed with diffuse intravascular coagulation (DIC) on admission, whereas eight patients were diagnosed with DIC on the day of death. CONCLUSION Coagulation dysfunction after severe burn is mainly characterized by procoagulant disorders and hyperfibrinolysis, which can be timely detected by TEG. Coagulation after severe burn exhibits a gradual aggravation, and can lead to death of patients.
Collapse
Affiliation(s)
- Quan Li
- Department of Burn Surgery, Institute of Burn Research of Inner Mongolia, The Third Affiliated Hospital of Inner Mongolia Medical University, Baogang Hospital, No. 20 Shaoxian Road, Kundulun District, Baotou 014010, China
| | - Tiening Zhang
- Department of Burn Surgery, Institute of Burn Research of Inner Mongolia, The Third Affiliated Hospital of Inner Mongolia Medical University, Baogang Hospital, No. 20 Shaoxian Road, Kundulun District, Baotou 014010, China
| | - Lingfeng Wang
- Department of Burn Surgery, Institute of Burn Research of Inner Mongolia, The Third Affiliated Hospital of Inner Mongolia Medical University, Baogang Hospital, No. 20 Shaoxian Road, Kundulun District, Baotou 014010, China
| | - Fang Li
- Department of Burn Surgery, Institute of Burn Research of Inner Mongolia, The Third Affiliated Hospital of Inner Mongolia Medical University, Baogang Hospital, No. 20 Shaoxian Road, Kundulun District, Baotou 014010, China
| | - Qiang Chen
- Department of Burn Surgery, Institute of Burn Research of Inner Mongolia, The Third Affiliated Hospital of Inner Mongolia Medical University, Baogang Hospital, No. 20 Shaoxian Road, Kundulun District, Baotou 014010, China
| | - Shengjun Cao
- Department of Burn Surgery, Institute of Burn Research of Inner Mongolia, The Third Affiliated Hospital of Inner Mongolia Medical University, Baogang Hospital, No. 20 Shaoxian Road, Kundulun District, Baotou 014010, China.
| | - Te Ba
- Department of Burn Surgery, Institute of Burn Research of Inner Mongolia, The Third Affiliated Hospital of Inner Mongolia Medical University, Baogang Hospital, No. 20 Shaoxian Road, Kundulun District, Baotou 014010, China.
| |
Collapse
|
13
|
Li J, Li R, Jin X, Ren J, Du L, Zhang J, Gao Y, Liu X, Hou Y, Zhang L, Song Z, Song J, Wang X, Wang G. Association of platelet count with mortality in patients with infectious diseases in intensive care unit: a multicenter retrospective cohort study. Platelets 2022; 33:1168-1174. [PMID: 35485162 DOI: 10.1080/09537104.2022.2066646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Platelets play important roles in thrombosis, hemostasis, inflammation, and infection. We aimed to evaluate the association between platelet count and its variation trend and prognosis of patient with infectious diseases in intensive care units (ICUs). This retrospective cohort study extracted 4,251 critically ill adult patients with infectious diseases from the eICU Collaborative Research Database, whose platelet counts were measured daily during the first 7 days after admission. In the survivors, platelet counts decreased in the first days after admission, reached a nadir on day 3, and then returned and continued to rise above the admission value. In non-survivors, the platelet counts decreased after admission, without a subsequent upturn. We defined three subgroups according to the nadir platelet counts within 7 days: ≤50, 50-130, and ≥130 × 109/L, corresponding to high, intermediate, and low ICU mortality. A decreased platelet count was associated with increased ICU mortality (intermediate vs. low: 1.676 [1.285-2.187]; high vs. low: 3.632 [2.611-5.052]). In conclusion, during the first 7 days, platelet counts decreased after ICU admission, while increased subsequently in the survivors but not in the non-survivors. ICU mortality risk increased as nadir platelet count decreased below 130 × 109/L, and further boosted when it reached below 50 × 109/L.
Collapse
Affiliation(s)
- Jiamei Li
- Department of Critical Care Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Ruohan Li
- Department of Critical Care Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Xuting Jin
- Department of Critical Care Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Jiajia Ren
- Department of Critical Care Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Linyun Du
- Department of Critical Care Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Jingjing Zhang
- Department of Critical Care Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Ya Gao
- Department of Critical Care Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Xiu Liu
- Department of Critical Care Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yanli Hou
- Department of Critical Care Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Lei Zhang
- Department of Laboratory Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Zhenju Song
- Department of Emergency Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jingchun Song
- Department of Critical Care Medicine, The 908th Hospital of Joint Logistics Support Forces of Chinese PLA, Nanchang, China
| | - Xiaochuang Wang
- Department of Critical Care Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Gang Wang
- Department of Critical Care Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| |
Collapse
|
14
|
Lin JC, Wu GH, Zheng JJ, Chen ZH, Chen XD. Prognostic Values of Platelet Distribution Width and Platelet Distribution Width-to-Platelet Ratio in Severe Burns. Shock 2022; 57:494-500. [PMID: 34812187 PMCID: PMC8906250 DOI: 10.1097/shk.0000000000001890] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 10/06/2021] [Accepted: 11/09/2021] [Indexed: 12/02/2022]
Abstract
BACKGROUND Platelet distribution width (PDW) and PDW-to-platelet ratio (PPR) have been proven to be good prognostic indicators for many diseases. However, their prognostic values in severe burns have not been reported. OBJECTIVE To investigate the early time course of PDW and PPR in severe burn patients and investigate their prognostic values. METHODS This is a 16-year, single-center retrospective study of 590 severe burn patients. The complete blood count parameters on day 1, day 3, and day 7 postburn, including PDW and PPR, were collected. Receiver operating characteristic curves (ROC) analysis, multiple logistic regression analysis and Kaplan-Meier survival analysis were performed to evaluate the prognostic values of PDW and PPR in severe burn patients. RESULTS According to 120-day follow-up records, 96 patients were nonsurvivors and 494 patients were survivors. ROC and area under the curve (AUC) analysis showed that, for predicting 120-day prognosis, the AUC of PDW (0.782) and PPR (0.816) on day 3 was the highest, followed by the AUC of PDW (0.764) and PPR (0.750) on day 7. The ROC-AUC of PPR (0.816) on day 3 was very close to that of the ABSI score (0.818). Multiple logistic regression analysis showed that the PDW (P = 0.033 and P = 0.009) and PPR (P = 0.052 and P = 0.046) on day 3 and day 7 were all significantly independently positively associated with 120-day mortality. Kaplan-Meier survival analysis showed that high PDW and PPR were both significantly associated with a high 120-day mortality rate on day 3 and day 7. CONCLUSION PDW and PPR on day 3 and day 7 were independent risk factors for 120-day mortality in severe burn patients. These objective and readily available prognostic indicators may be more clinically favored.
Collapse
Affiliation(s)
- Jian-Chang Lin
- Fujian Provincial Key Laboratory of Burn and Trauma, Fujian Burn Institute, Fujian Burn Medical Center, Fujian Medical University Union Hospital, Fuzhou 350001, Fujian, China
| | | | | | | | | |
Collapse
|
15
|
Johnson BZ, Stevenson AW, Barrett LW, Fear MW, Wood FM, Linden MD. Platelets after burn injury - hemostasis and beyond. Platelets 2022; 33:655-665. [PMID: 34986759 DOI: 10.1080/09537104.2021.1981849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Burn injuries are common and often life-threatening trauma. With this trauma comes an interruption of normal hemostasis, with distinct impacts on platelets. Our interest in the relationships between burn injury and platelet function stems from two key perspectives: platelet function is a vital component of acute responses to injury, and furthermore the incidence of cardiovascular disease (CVD) is higher in burn survivors compared to the general population. This review explores the impact of burn injury on coagulation, platelet function, and the participation of platelets in immunopathology. Potential avenues of further research are explored, and consideration is given to what therapies may be appropriate for mediating post-burn thrombopathology.
Collapse
Affiliation(s)
- B Z Johnson
- Burn Injury Research Unit, University of Western Australia, Perth, Australia.,School of Biomedical Science, University of Western Australia, Perth, Australia
| | - A W Stevenson
- Burn Injury Research Unit, University of Western Australia, Perth, Australia.,School of Biomedical Science, University of Western Australia, Perth, Australia
| | - L W Barrett
- Burn Injury Research Unit, University of Western Australia, Perth, Australia.,Telethon Kids Institute, University of Western Australia, Perth, Australia
| | - M W Fear
- Burn Injury Research Unit, University of Western Australia, Perth, Australia.,School of Biomedical Science, University of Western Australia, Perth, Australia
| | - F M Wood
- Burn Injury Research Unit, University of Western Australia, Perth, Australia.,Burns Service of Western Australia, Wa Department of Health, Nedlands, Australia
| | - M D Linden
- School of Biomedical Science, University of Western Australia, Perth, Australia
| |
Collapse
|
16
|
Hu G, Zhang P, Chen Y, Yuan Z, Song H. Efficacy of two-stage Meek micrografting in patients with severe burns. J Burn Care Res 2021; 43:1081-1085. [PMID: 34902020 DOI: 10.1093/jbcr/irab241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Burns are common injuries associated with high disability and mortality. In recent years, Meek micrografting technique has been gradually applied for the wound treatment of severe burns. However, the efficacy of two-stage Meek micrografting in patients with severe burns keeps unclear. METHODS The data of eligible patients with severe burns who were admitted to Southwest Hospital of the Third Military Medical University from January 2013 to December 2019 were retrospectively analysed. The patients were divided into two groups according to the Meek micrografting method: one-stage skin grafting (group A) and two-stage skin grafting (group B). The baseline data, survival rate of skin graft, length of hospital stay, treatment costs, laboratory data and cumulative survival were statistically analysed. RESULTS 127 patients (91 in group A and 36 in group B) were included in the study. There were no significant difference in the baseline data, the length of hospital stay and treatment costs between the two groups. The survival rate of skin graft was higher in group B. Total protein and albumin level, platelet count in group B were superior to those in group A, while there were no difference in other laboratory data (prealbumin, serum creatinine, urea nitrogen, cystatin C, blood cultures, wound exudate cultures) and cumulative survival between the two groups. CONCLUSION Our results demonstrated that staged Meek micrografting could improve the survival rate of skin graft, by reducing the risks of hypoproteinaemia, hypoalbuminemia and low platelet counts after adequate resuscitation.
Collapse
Affiliation(s)
- Gaozhong Hu
- Department of Burns, State Key Laboratory of Trauma, Burn and Combined Injury, Institute of Burn Research, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Peng Zhang
- Department of Burns, State Key Laboratory of Trauma, Burn and Combined Injury, Institute of Burn Research, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Yan Chen
- Department of Burns, State Key Laboratory of Trauma, Burn and Combined Injury, Institute of Burn Research, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Zhiqiang Yuan
- Department of Burns, State Key Laboratory of Trauma, Burn and Combined Injury, Institute of Burn Research, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Huapei Song
- Department of Burns, State Key Laboratory of Trauma, Burn and Combined Injury, Institute of Burn Research, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| |
Collapse
|
17
|
Cato LD, Bailiff B, Price J, Ermogeneous C, Hazeldine J, Lester W, Lowe G, Wearn C, Bishop JRB, Lord JM, Moiemen N, Harrison P. Heparin resistance in severe thermal injury: A prospective cohort study. BURNS & TRAUMA 2021; 9:tkab032. [PMID: 34692855 PMCID: PMC8528639 DOI: 10.1093/burnst/tkab032] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 04/06/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Low molecular-weight heparin (LMWH) is routinely administered to burn patients for thromboprophylaxis. Some studies have reported heparin resistance, yet the mechanism(s) and prevalence have not been systematically studied. We hypothesized that nucleosomes, composed of histone structures with associated DNA released from injured tissue and activated immune cells in the form of neutrophil extracellular traps (NETs or NETosis), neutralize LMWH resulting in suboptimal anticoagulation, assessed by reduction in anti-factor Xa activity. METHODS Blood was sampled from >15% total body surface area (TBSA) burn patients receiving LMWH on days 5, 10 and 14. Peak anti-factor Xa (AFXa) activity, anti-thrombin (ATIII) activity, cell-free DNA (cfDNA) levels and nucleosome levels were measured. Mixed effects regression was adjusted for multiple confounders, including injury severity and ATIII activity, and was used to test the association between nucleosomes and AFXa. RESULTS A total of 30 patients with severe burns were included. Mean TBSA 43% (SD 17). Twenty-three (77%) patients were affected by heparin resistance (defined by AFXa activity <0.2 IU/mL). Mean peak AFXa activity across samples was 0.18 IU/mL (SD 0.11). Mean ATIII was 81.9% activity (SD 20.4). Samples taken at higher LWMH doses were found to have significantly increased AFXa activity, though the effect was not observed at all doses, at 8000 IU no samples were heparin resistant. Nucleosome levels were negatively correlated with AFXa (r = -0.29, p = 0.050) consistent with the hypothesis. The final model, with peak AFXa as the response variable, was adjusted for nucleosome levels (p = 0.0453), ATIII activity (p = 0.0053), LMWH dose pre-sample (p = 0.0049), drug given (enoxaparin or tinzaparin) (p = 0.03), and other confounders including severity of injury, age, gender, time point of sample. CONCLUSIONS Heparin resistance is a prevalent issue in severe burns. Nucleosome levels were increased post-burn, and showed an inverse association with AFXa consistent with the hypothesis that they may interfere with the anticoagulant effect of heparin in vivo and contribute to heparin resistance. Accurate monitoring of AFXa activity with appropriate therapy escalation plans are recommended with dose adjustment following severe burn injury.
Collapse
Affiliation(s)
- Liam D Cato
- Scar Free Foundation Birmingham Centre for Burns Research, University Hospitals Birmingham Foundation Trust, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Birmingham, B15 2WB, UK
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, B15 2TT, UK
| | - Benjamin Bailiff
- Department of Haematology, University Hospitals Birmingham Foundation Trust, Mindelsohn Way, Birmingham, B15 2WB, UK
| | - Joshua Price
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, B15 2TT, UK
| | - Christos Ermogeneous
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, B15 2TT, UK
| | - Jon Hazeldine
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, B15 2TT, UK
| | - William Lester
- Department of Haematology, University Hospitals Birmingham Foundation Trust, Mindelsohn Way, Birmingham, B15 2WB, UK
| | - Gillian Lowe
- Department of Haematology, University Hospitals Birmingham Foundation Trust, Mindelsohn Way, Birmingham, B15 2WB, UK
| | - Christopher Wearn
- Scar Free Foundation Birmingham Centre for Burns Research, University Hospitals Birmingham Foundation Trust, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Birmingham, B15 2WB, UK
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, B15 2TT, UK
| | - Jonathan R B Bishop
- NIHR Surgical Reconstruction and Microbiology Research Centre, University Hospitals Birmingham Foundation Trust, Mindelsohn Way, Birmingham, B15 2WB, UK
| | - Janet M Lord
- Scar Free Foundation Birmingham Centre for Burns Research, University Hospitals Birmingham Foundation Trust, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Birmingham, B15 2WB, UK
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, B15 2TT, UK
- NIHR Surgical Reconstruction and Microbiology Research Centre, University Hospitals Birmingham Foundation Trust, Mindelsohn Way, Birmingham, B15 2WB, UK
| | - Naiem Moiemen
- Scar Free Foundation Birmingham Centre for Burns Research, University Hospitals Birmingham Foundation Trust, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Birmingham, B15 2WB, UK
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, B15 2TT, UK
- NIHR Surgical Reconstruction and Microbiology Research Centre, University Hospitals Birmingham Foundation Trust, Mindelsohn Way, Birmingham, B15 2WB, UK
| | - Paul Harrison
- Scar Free Foundation Birmingham Centre for Burns Research, University Hospitals Birmingham Foundation Trust, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Birmingham, B15 2WB, UK
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, B15 2TT, UK
- NIHR Surgical Reconstruction and Microbiology Research Centre, University Hospitals Birmingham Foundation Trust, Mindelsohn Way, Birmingham, B15 2WB, UK
| |
Collapse
|
18
|
Loibl C, Rozanovic M, Bogár L, Pankaczi A, Kovács P, Miseta A, Molnár T, Csontos C. Lack of early platelet and leukocyte activation can indicate complications after major burn injury. Clin Hemorheol Microcirc 2021; 77:17-26. [PMID: 32538824 DOI: 10.3233/ch-190779] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Major burn injury causes massive tissue destruction consequently enhanced platelet function and leukocyte-mediated inflammatory response. METHODS In a prospective, observational study 23 consecutive patients with more than 20% body surface burn injury were followed for five days (T1-T5) after admission to a university intensive care (ICU). Platelet and leukocyte antisedimentation rate (PAR and LAR) was measured by one-hour gravity sedimentation. It detects the percentage of total platelet and leukocyte number crossed the half line of blood sample column, therefore, they can be regarded as cells of decreased specific gravity. We aimed to investigate the time course of PAR and LAR after burn injury, as the trend of platelet and the leukocyte activation in the early post-burn period. RESULTS Daily mean PAR and LAR values continuously increased in the observation period (T1 to T5). Daily mean PAR and LAR were lower in ICU non-survivors (n = 7) compared to survivors (n = 16) between T2 and T4 (p < 0.05 and p < 0.01). PAR values of septic patients (n = 10) were lower than that of non-septic ones (n = 13, p < 0.01 at T5). CONCLUSIONS Both PAR and LAR, as novel bedside test can predict septic complications and unfavorable outcome after major burn injury. Further studies with higher sample size are warranted.
Collapse
Affiliation(s)
- Csaba Loibl
- Department of Anesthesiology and Intensive Care, University of Pécs Medical School, Pécs, Hungary
| | - Martin Rozanovic
- Department of Anesthesiology and Intensive Care, University of Pécs Medical School, Pécs, Hungary
| | - Lajos Bogár
- Department of Anesthesiology and Intensive Care, University of Pécs Medical School, Pécs, Hungary
| | - Andrea Pankaczi
- Department of Anesthesiology and Intensive Care, University of Pécs Medical School, Pécs, Hungary
| | - Patrícia Kovács
- Department of Anesthesiology and Intensive Care, University of Pécs Medical School, Pécs, Hungary
| | - Attila Miseta
- Department of Laboratory Medicine, University of Pécs Medical School, Pécs, Hungary
| | - Tihamér Molnár
- Department of Anesthesiology and Intensive Care, University of Pécs Medical School, Pécs, Hungary
| | - Csaba Csontos
- Department of Anesthesiology and Intensive Care, University of Pécs Medical School, Pécs, Hungary
| |
Collapse
|
19
|
Chae YJ, Lee J, Park JH, Han DG, Ha E, Yi IK. Late Mortality Prediction of Neutrophil-to-lymphocyte and Platelet Ratio in Patients With Trauma Who Underwent Emergency Surgery: A Retrospective Study. J Surg Res 2021; 267:755-761. [PMID: 33583601 DOI: 10.1016/j.jss.2020.11.088] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 09/28/2020] [Accepted: 11/01/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND We aimed to evaluate the usefulness of neutrophil-to-lymphocyte (N/L) and neutrophil-to-lymphocyte platelet (N/LP) ratios in predicting late mortality of patients with trauma who underwent emergency surgery. MATERIALS AND METHODS We retrospectively evaluated patients with trauma older than 19 y who underwent emergency surgery at our level I trauma center. Blood count-based ratios (N/L and N/LP at days 1, 3, and 7 of hospitalization) and trauma scores were analyzed. Statistical analysis was performed using univariable logistic regression and receiver operating curves. RESULTS A total of 209 patients were evaluated. N/LP at day 7, N/L at day 7, Trauma Injury Severity Score, Revised Trauma Score, and Injury Severity Score were significantly associated with late mortality. Area under the receiver operating characteristic curves for predicting mortality was highest for N/LP at day 7 (0.867 [95% confidence interval 0.798-0.936], P < 0.001). The group with N/LP greater than the cutoff value (9.3, sensitivity 77.3%, specificity 83.1%) at day 7 showed higher mortality than the group with N/LP less than the cutoff value (35.4% versus 3.2%, P < 0.001, respectively) at day 7. CONCLUSIONS N/LP at day 7 may be a superior predictor of late mortality compared with preexisting trauma scores in patients with major trauma undergoing emergency surgery, by better reflecting the systemic inflammation status.
Collapse
Affiliation(s)
- Yun Jeong Chae
- Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, Suwon, South Korea
| | - Jiyoung Lee
- Department of Anesthesiology and Pain Medicine CHA Bundang Medical Center, CHA University, Seongnam, South Korea
| | - Ji Hyun Park
- Office of Biostatistics, Ajou Research Institute for Innovation Medicine, Ajou University Medical Center, Suwon, South Korea
| | - Do-Gyun Han
- Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, Suwon, South Korea
| | - Eunji Ha
- Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, Suwon, South Korea
| | - In Kyong Yi
- Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, Suwon, South Korea.
| |
Collapse
|
20
|
Bandeira NG, Barroso MVVS, Matos MAA, Filho ALM, Figueredo AA, Gravina PR, Klein SOT. Serum albumin concentration on admission as a predictor of morbidity and mortality in patients with burn injuries. J Burn Care Res 2021; 42:991-997. [PMID: 33481997 DOI: 10.1093/jbcr/irab004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Efforts have been made to determine new predictors of morbidity and mortality in patients with severe burn injuries. This prospective cohort study aimed to determine the association of serum albumin concentration on admission and renal failure, pulmonary infection, sepsis, and death in patients with burn injuries. We included 141 patients, aged >18 years, who were admitted to our institution between April and August 2018. Among them, 59.1% were male and 83.8% had burns covering <20% of the body surface area. Scalds were the most common cause of burns (34.8%). Twelve patients died, of whom eight (66.6%) had an Abbreviated Burn Severity Index (ABSI) ≥8. Patients with serum albumin ≤2.2 g/dL had a higher mortality rate than those with >2.2 g/dL (odds ratios [OR]: 18.7; 95% confidence interval [CI]: 4.9-70.8). Serum albumin ≤2.2 g/dL was also significantly associated with pulmonary infection (OR: 13.1, 95%CI: 3.8-45.7), renal failure (OR: 30.2, 95% CI: 7.4-122.3), and sepsis (OR: 16.9, 95% CI: 4.9-58.3). Serum albumin concentration cut-points and ABSIs were determined to be death predictors using areas under the receiver operating characteristic curves (AUCs). The AUCs with albumin or ABSI alone were 0.89 (95% CI: 0.79-0.98) and 0.92 (95% CI: 0.87-0.96), respectively. The AUC including both albumin and ABSI was 0.96 (95% CI: 0.90-0.98), indicating that the combination is a better death predictor than either measure alone. We confirmed that burn patients with a serum albumin concentration ≤2.2 g/dL on admission have substantially increased morbidity and mortality.
Collapse
Affiliation(s)
- Nilmar G Bandeira
- Burn Treatment Center, Hospital Geral do Estado da Bahia (Bahia State General Hospital), Salvador, Brazil
| | | | - Marcos Antônio A Matos
- Academic Master's Program, Escola Bahiana de Medicina e Saúde Pública, Salvador, Bahia, Brazil
| | - Alexandre L M Filho
- Burn Treatment Center, Hospital Geral do Estado da Bahia (Bahia State General Hospital), Salvador, Brazil
| | - Adson A Figueredo
- Burn Treatment Center, Hospital Geral do Estado da Bahia (Bahia State General Hospital), Salvador, Brazil
| | - Paula R Gravina
- Department of Plastic Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Sibele O T Klein
- Universidade Federal do Recôncavo da Bahia (Federal University of Recôncavo da Bahia) and Academic Graduate Program in Health Technologies, Escola Bahiana de Medicina e Saúde Pública (Bahiana School of Medicine and Public Health), Salvador, Brazil
| |
Collapse
|
21
|
Yoon J, Kym D, Hur J, Won JH, Yim H, Cho YS, Chun W. Time-varying discrimination accuracy of longitudinal biomarkers for the prediction of mortality compared to assessment at fixed time point in severe burns patients. BMC Emerg Med 2021; 21:1. [PMID: 33407163 PMCID: PMC7786914 DOI: 10.1186/s12873-020-00394-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 12/11/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The progression of biomarkers over time is considered an indicator of disease progression and helps in the early detection of disease, thereby reducing disease-related mortality. Their ability to predict outcomes has been evaluated using conventional cross-sectional methods. This study investigated the prognostic performance of biomarkers over time. METHODS Patients aged > 18 years admitted to the burn intensive care unit within 24 h of a burn incident were enrolled. Information regarding longitudinal biomarkers, including white blood cells; platelet count; lactate, creatinine, and total bilirubin levels; and prothrombin time (PT), were retrieved from a clinical database. Time-dependent receiver operating characteristic curves using cumulative/dynamic and incident/dynamic (ID) approaches were used to evaluate prognostic performance. RESULTS Overall, 2259 patients were included and divided into survival and non-survival groups. By determining the area under the curve using the ID approach, platelets showed the highest c-index [0.930 (0.919-0.941)] across all time points. Conversely, the c-index of PT and creatinine levels were 0.862 (0.843-0.881) and 0.828 (0.809-0.848), respectively. CONCLUSIONS Platelet count was the best prognostic marker, followed by PT. Total bilirubin and creatinine levels also showed good prognostic ability. Although lactate was a strong predictor, it showed relatively poor prognostic performance in burns patients.
Collapse
Affiliation(s)
- Jaechul Yoon
- Department of Surgery and Critical Care, Burn Center, Hangang Sacred Heart Hospital, College of Medicine, Hallym University Medical Center, 12, Beodeunaru-ro 7-gil, Youngdeungpo-gu, Seoul, 07247, South Korea
- Graduate School of Medicine, Kangwon National University, Chuncheon, Republic of Korea
| | - Dohern Kym
- Department of Surgery and Critical Care, Burn Center, Hangang Sacred Heart Hospital, College of Medicine, Hallym University Medical Center, 12, Beodeunaru-ro 7-gil, Youngdeungpo-gu, Seoul, 07247, South Korea
| | - Jun Hur
- Department of Surgery and Critical Care, Burn Center, Hangang Sacred Heart Hospital, College of Medicine, Hallym University Medical Center, 12, Beodeunaru-ro 7-gil, Youngdeungpo-gu, Seoul, 07247, South Korea.
| | - Jae Hee Won
- Department of Surgery and Critical Care, Burn Center, Hangang Sacred Heart Hospital, College of Medicine, Hallym University Medical Center, 12, Beodeunaru-ro 7-gil, Youngdeungpo-gu, Seoul, 07247, South Korea
| | - Haejun Yim
- Department of Surgery and Critical Care, Burn Center, Hangang Sacred Heart Hospital, College of Medicine, Hallym University Medical Center, 12, Beodeunaru-ro 7-gil, Youngdeungpo-gu, Seoul, 07247, South Korea
| | - Yong Suk Cho
- Department of Surgery and Critical Care, Burn Center, Hangang Sacred Heart Hospital, College of Medicine, Hallym University Medical Center, 12, Beodeunaru-ro 7-gil, Youngdeungpo-gu, Seoul, 07247, South Korea
| | - Wook Chun
- Department of Surgery and Critical Care, Burn Center, Hangang Sacred Heart Hospital, College of Medicine, Hallym University Medical Center, 12, Beodeunaru-ro 7-gil, Youngdeungpo-gu, Seoul, 07247, South Korea
| |
Collapse
|
22
|
Lin JC, Xu ZR, Chen ZH, Chen XD. Low-soluble TREM-like transcript-1 levels early after severe burn reflect increased coagulation disorders and predict 30-day mortality. Burns 2020; 47:1322-1332. [PMID: 33958244 DOI: 10.1016/j.burns.2020.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 11/24/2020] [Accepted: 11/27/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Patients with severe burns often show systemic coagulation changes in the early stage and even develop extensive coagulopathy. Previous studies have confirmed that soluble TREM-like transcript-1 (sTLT-1) mediates a novel mechanism of haemostasis and thrombosis in inflammatory vascular injury. At present, the role of sTLT-1 in patients with severe burns is not well known. OBJECTIVE To investigate the early association between sTLT-1 levels and markers of burn severity, coagulation disorders, endothelial permeability, shock and prognosis in patients with severe burns. METHODS A prospective, observational study was conducted with 60 severe burn patients (divided into a death group and a survival group according to 30-day prognosis) admitted to our hospital. Twenty-eight healthy volunteers were recruited as the control group. Blood components at 48 h after burn were analysed for sTLT-1 and biomarkers reflecting platelet activation, shock, endothelial glycocalyx damage, capillary leakage, haemostasis, fibrinolytic activity, natural anticoagulation and blood cells. We compared the three groups, analysed the correlation between sTLT-1 and biomarkers, and investigated the predictive value of sTLT-1 for 30-day prognosis. RESULT Compared with the surviving patients, the patients who died had a lower degree of platelet activation [lower sTLT-1, platelet factor 4 (PF-4) and platelet counts] and a higher degree of burn [higher abbreviated burn severity index score (ABSI score)], shock (higher lactate), endothelial glycocalyx damage [higher syndecan-1 and soluble thrombomodulin (sTM)] and capillary leakage [higher resuscitation fluid (0-48 h), lower albumin] as well as decreased haemostasis [higher activated partial prothrombin time (APTT), lower fibrinogen and thrombin-antithrombin III complex (TAT)], increased fibrinolytic activity [higher D-dimer and tissue-type plasminogen activator (tPA)] and decreased natural anticoagulation [lower protein C (PC) and protein S (PS)]. Higher D-dimer (P = 0.013) and lower PF-4 (P = 0.001) were significantly independently associated with lower sTLT-1. Low circulating sTLT-1 (a unit is 50 pg/mL) (odds ratio [OR] 2.08 [95% CI 1.11-3.92], P = 0.022) was an independent predictor of increased 30-day mortality. CONCLUSION Low sTLT-1 levels at 48 h after burn in patients with severe burns is associated with increased coagulation disorders. Low circulating sTLT-1 levels were an independent predictor of increased 30-day mortality.
Collapse
Affiliation(s)
- Jian-Chang Lin
- Fujian Provincial Key Laboratory of Burn and Trauma, Fujian Burn Institute, Fujian Burn Medical Center, Fujian Medical University Union Hospital, Fuzhou 350001, Fujian, China.
| | - Zhao-Rong Xu
- Fujian Provincial Key Laboratory of Burn and Trauma, Fujian Burn Institute, Fujian Burn Medical Center, Fujian Medical University Union Hospital, Fuzhou 350001, Fujian, China.
| | - Zhao-Hong Chen
- Fujian Provincial Key Laboratory of Burn and Trauma, Fujian Burn Institute, Fujian Burn Medical Center, Fujian Medical University Union Hospital, Fuzhou 350001, Fujian, China.
| | - Xiao-Dong Chen
- Fujian Provincial Key Laboratory of Burn and Trauma, Fujian Burn Institute, Fujian Burn Medical Center, Fujian Medical University Union Hospital, Fuzhou 350001, Fujian, China.
| |
Collapse
|
23
|
Ge S, Lin S, Zhang L, Zeng M. The Association of Red Blood Cell Distribution Width to Platelet Count Ratio and 28-Day Mortality of Patients with Sepsis: A Retrospective Cohort Study. Ther Clin Risk Manag 2020; 16:999-1006. [PMID: 33116549 PMCID: PMC7586012 DOI: 10.2147/tcrm.s268523] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 09/11/2020] [Indexed: 12/18/2022] Open
Abstract
Background Sepsis is a life-threatening and inflammatory disease with high morbidity and mortality. Red blood cell distribution width to platelet count ratio (RPR) was known as an inflammatory biomarker and was related to poor outcomes of various diseases. Aim This study was intended to explore the association between RPR and mortality of sepsis patients. Methods A retrospective cohort study was undertaken in patients with sepsis, and the data were collected from a public database called Medical Information Mart for Intensive Care III (MIMIC-III). The primary outcome was 28-day mortality while the secondary outcomes were 90-day mortality and ICU mortality. Multivariable regression analyses, as well as interaction and stratified analyses, were conducted to investigate the relation between RPR and sepsis mortality. Results In total, we enrolled 7531 patients with 1316 deaths. RPR was independently correlated with 28-day mortality (per 0.1 increase: HR=1.04; 95% CI 1.02–1.06), 90-day mortality (per 0.1 increase: HR=1.04; 95% CI 1.03–1.06) and ICU mortality (per 0.1 increase: OR=1.06; 95% CI 1.02–1.10). Twenty-eight-day survival was worse in the high RPR (≥0.134) group according to the Kaplan–Meier curve analyses (Log rank test, p<0.001). In stratified analyses, Sequential Organ Failure Assessment (SOFA) score and length of ICU stay had interactive effects with the high RPR (≥0.134) group on 28-day mortality. Conclusion RPR is a novel biomarker that indicates poor prognosis of sepsis patients. Clinicians are required to pay more attention to those patients with high RPR.
Collapse
Affiliation(s)
- Shanhui Ge
- Department of Medical Intensive Care Unit, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510080, China; Institute of Pulmonary Diseases, Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China
| | - Shan Lin
- Department of Medical Intensive Care Unit, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510080, China; Institute of Pulmonary Diseases, Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China
| | - Lishan Zhang
- Department of Medical Intensive Care Unit, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510080, China; Institute of Pulmonary Diseases, Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China
| | - Mian Zeng
- Department of Medical Intensive Care Unit, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510080, China; Institute of Pulmonary Diseases, Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China
| |
Collapse
|
24
|
Yoon J, Kym D, Won JH, Hur J, Yim H, Cho YS, Chun W. Trajectories of longitudinal biomarkers for mortality in severely burned patients. Sci Rep 2020; 10:16193. [PMID: 33004974 PMCID: PMC7530734 DOI: 10.1038/s41598-020-73286-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 09/15/2020] [Indexed: 11/26/2022] Open
Abstract
This study aimed to investigate the differences in the trajectory of blood biomarkers routinely assessed through forward- and backward-looking approaches among burn patients. This cohort study included patients above 18 years of age from February 2007 to December 2018. All the biomarkers were estimated from admission to discharge from the intensive care unit. Significant differences were observed in the platelet count at 40 days, prothrombin time (PT) at 32 days, white blood cell count at 26 days, creatinine levels at 22 days, and lactate and total bilirubin levels at 19 days before death. In reverse order, significant differences were observed in the fitted model in platelet count at 44 days and in the platelet count and PT at 33 days. We obtained more valuable information from the longitudinal biomarker trajectory using the backward-looking method than using the forward-looking method. The platelet count served as the earliest predictor of mortality among burn patients.
Collapse
Affiliation(s)
- Jaechul Yoon
- Department of Surgery and Critical Care, Burn Center, Hangang Sacred Heart Hospital, College of Medicine, Hallym University, 12, Beodeunaru-ro 7-gil, Youngdeungpo-gu, Seoul, 07247, Republic of Korea.,Graduate School of Medicine, Kangwon National University, Chuncheon, Republic of Korea
| | - Dohern Kym
- Department of Surgery and Critical Care, Burn Center, Hangang Sacred Heart Hospital, College of Medicine, Hallym University, 12, Beodeunaru-ro 7-gil, Youngdeungpo-gu, Seoul, 07247, Republic of Korea
| | - Jae Hee Won
- Department of Surgery and Critical Care, Burn Center, Hangang Sacred Heart Hospital, College of Medicine, Hallym University, 12, Beodeunaru-ro 7-gil, Youngdeungpo-gu, Seoul, 07247, Republic of Korea
| | - Jun Hur
- Department of Surgery and Critical Care, Burn Center, Hangang Sacred Heart Hospital, College of Medicine, Hallym University, 12, Beodeunaru-ro 7-gil, Youngdeungpo-gu, Seoul, 07247, Republic of Korea.
| | - Haejun Yim
- Department of Surgery and Critical Care, Burn Center, Hangang Sacred Heart Hospital, College of Medicine, Hallym University, 12, Beodeunaru-ro 7-gil, Youngdeungpo-gu, Seoul, 07247, Republic of Korea
| | - Yong Suk Cho
- Department of Surgery and Critical Care, Burn Center, Hangang Sacred Heart Hospital, College of Medicine, Hallym University, 12, Beodeunaru-ro 7-gil, Youngdeungpo-gu, Seoul, 07247, Republic of Korea
| | - Wook Chun
- Department of Surgery and Critical Care, Burn Center, Hangang Sacred Heart Hospital, College of Medicine, Hallym University, 12, Beodeunaru-ro 7-gil, Youngdeungpo-gu, Seoul, 07247, Republic of Korea
| |
Collapse
|
25
|
Angulo M, Moreno L, Aramendi I, Dos Santos G, Cabrera J, Burghi G. Complete Blood Count and Derived Indices: Evolution Pattern and Prognostic Value in Adult Burned Patients. J Burn Care Res 2020; 41:1260-1266. [PMID: 32511725 DOI: 10.1093/jbcr/iraa091] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Certain parameters of complete blood count (CBC) such as red cell distribution width (RDW) and mean platelet volume, as well as neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and RDW-to-platelet ratio (RPR) have been associated with inflammatory status and outcome in diverse medical conditions. The aim of this study was to describe the evolution pattern of these parameters in adult burned patients. Adult burned patients admitted to the National Burn Center in Uruguay between May 2017 and February 2018 (discovery cohort) and between March 2018 and August 2019 (validation cohort) were included. Patients' characteristics and outcomes were recorded, as well as CBC parameters on days 1, 3, 5, and 7 after thermal injury. Eighty-eight patients were included in the discovery cohort. Total body surface area burned was 14 [7-23]% and mortality was 15%. Nonsurvivors presented higher RDW and mean platelet volume (P < .01). NLR decreased after admission in all patients (P < .01), but was higher in nonsurvivors (P < .01). Deceased patients also presented higher RPR on days 3, 5, and 7 (P < .001). On the contrary, PLR was reduced in nonsurvivors (P < .05). There was a significant correlation between NLR on admission and burn extension and severity. Kaplan-Meier analysis revealed that NLR, PLR, and RPR could identify patients with increased mortality. These findings were confirmed in the validation cohort (n = 95). Basic CBC parameters and derived indices could be useful as biomarkers to determine prognosis in adults with thermal injuries.
Collapse
Affiliation(s)
- Martín Angulo
- National Burn Center, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay.,Department of Critical Care Medicine, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay.,Department of Pathophysiology, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay
| | - Laura Moreno
- National Burn Center, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay.,Department of Critical Care Medicine, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay
| | - Ignacio Aramendi
- National Burn Center, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay.,Department of Critical Care Medicine, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay
| | - Gimena Dos Santos
- Department of Hematology, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay
| | - Julio Cabrera
- National Burn Center, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay.,Department of Critical Care Medicine, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay
| | - Gastón Burghi
- National Burn Center, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay.,Department of Critical Care Medicine, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay
| |
Collapse
|
26
|
McDonald B, Dunbar M. Platelets and Intravascular Immunity: Guardians of the Vascular Space During Bloodstream Infections and Sepsis. Front Immunol 2019; 10:2400. [PMID: 31681291 PMCID: PMC6797619 DOI: 10.3389/fimmu.2019.02400] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 09/25/2019] [Indexed: 12/12/2022] Open
Abstract
Despite their humble origins as anuclear fragments of megakaryocytes, platelets have emerged as versatile mediators of thrombosis and immunity. The diverse spectrum of platelet functions are on full display during the host response to severe infection and sepsis, with platelets taking center-stage in the intravascular immune response to blood-borne pathogens. Platelets are endowed with a comprehensive armamentarium of pathogen detection systems that enable them to function as sentinels in the bloodstream for rapid identification of microbial invasion. Through both autonomous anti-microbial effector functions and collaborations with other innate immune cells, platelets orchestrate a complex intravascular immune defense system that protects against bacterial dissemination. As with any powerful immune defense system, dysregulation of platelet-mediated intravascular immunity can lead to profound collateral damage to host cells and tissues, resulting in sepsis-associated organ dysfunction. In this article, the cellular and molecular contributions of platelets to intravascular immune defenses in sepsis will be reviewed, including the roles of platelets in surveillance of the microcirculation and elicitation of protective anti-bacterial responses. Mechanisms of platelet-mediated thromboinflammatory organ dysfunction will be explored, with linkages to clinical biomarkers of platelet homeostasis that aid in the diagnosis and prognostication of human sepsis. Lastly, we discuss novel therapeutic opportunities that take advantage of our evolving understanding of platelets and intravascular immunity in severe infection.
Collapse
Affiliation(s)
- Braedon McDonald
- Department of Critical Care Medicine, Snyder Institute for Chronic Diseases, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Mary Dunbar
- Department of Pediatrics, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| |
Collapse
|
27
|
Can systemic inflammatory response syndrome score at admission predict clinical outcome in patients with severe burns? Burns 2019; 45:860-868. [DOI: 10.1016/j.burns.2018.11.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 11/18/2018] [Accepted: 11/29/2018] [Indexed: 01/05/2023]
|
28
|
Dou J, Zhou Y, Cui Y, Chen M, Wang C, Zhang Y. AST-to-Platelet Ratio Index as Potential Early-Warning Biomarker for Sepsis-Associated Liver Injury in Children: A Database Study. Front Pediatr 2019; 7:331. [PMID: 31497584 PMCID: PMC6713043 DOI: 10.3389/fped.2019.00331] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 07/23/2019] [Indexed: 12/29/2022] Open
Abstract
Background: Sepsis-associated liver injury (SALI) is a risk factor of poor outcome in patients with sepsis. The early warning biomarkers for identifying SALI remain poorly defined. Aims: To identify the potential predictors of occurrence of SALI in pediatric patients with sepsis. Methods: We retrospectively analyzed the sepsis database based on the medical records of patients admitted to the pediatric intensive care unit (PICU) in Shanghai Children's Hospital from July 2014 to June 2018. Patients' demographics, co-morbidities and laboratory variables were collected. Univariate and multivariate logistic analysis were used to explore risk factors of SALI, and receiver operating characteristic (ROC) curve analysis was used to evaluate their predictive significances for SALI occurrence. Results: Of 1,645 eligible patients, 1,147 patients were included, and 105 cases had SALI. The indexes including AST-to-platelet ratio index (APRI), γ-GT and lactate dehydrogenase (LDH) were independent risk factors for SALI. Moreover, APRI was powerful to predict SALI in children (AUC: 0.889, 95% CI: 0.851-0.927) with a sensitivity of 84.6 % and a specificity of 84.3 % at the cutoff point of 0.340. APRI was superior to LDH and not inferior to γ-GT for predicting SALI. Conclusion: APRI is an independent risk factor of SALI occurrence, and elevated APRI within 24 h after PICU admission (>0.340) is a potential predictor for SALI in children.
Collapse
Affiliation(s)
- Jiaying Dou
- Department of Critical Care Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yiping Zhou
- Department of Critical Care Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yun Cui
- Department of Critical Care Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Min Chen
- Department of Information Technology, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Chunxia Wang
- Department of Critical Care Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China.,Institute of Pediatric Critical Care, Shanghai Jiao Tong University, Shanghai, China
| | - Yucai Zhang
- Department of Critical Care Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China.,Institute of Pediatric Critical Care, Shanghai Jiao Tong University, Shanghai, China
| |
Collapse
|
29
|
Alsousou J, Harrison P. Therapeutic Platelet-Rich Plasma in Wound Healing. Platelets 2019. [DOI: 10.1016/b978-0-12-813456-6.00065-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
|