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Cato LD, Wearn CM, Bishop JR, Stone MJ, Harrison P, Moiemen N. Platelet count: A predictor of sepsis and mortality in severe burns. Burns 2018; 44:288-297. [DOI: 10.1016/j.burns.2017.08.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Revised: 08/20/2017] [Accepted: 08/22/2017] [Indexed: 12/22/2022]
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Huang X, Guo F, Zhou Z, Chang M, Wang F, Dou Y, Wang Z, Huan J. Relation between dynamic changes of platelet counts and 30-day mortality in severely burned patients. Platelets 2017; 30:158-163. [PMID: 29252068 DOI: 10.1080/09537104.2017.1379599] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Thrombocytopenia is a common event in severely burned patients and associated with adverse outcome. The underlying relationship between the dynamic changes of platelet counts and mortality has not been well defined. We performed a 6-year retrospective chart of adult patients with a burn index of 50 or greater admitted to two burn centers and collected data on patient demographics, laboratory results, and patient outcomes. The mean daily increase in the platelet count (∆PC/∆t) from day 3 to day 10 was calculated, and 30-day mortality was determined. For the study, 141 survivors and 65 nonsurvivors were enrolled. The sequential changes in PCs presented a biphasic pattern after admission, with a slump to the nadir during the first 3 days and a subsequent recovery. With respect to 30-day mortality, compared with the AUC of APACHE-Ⅱ score (0.841), no significant difference was noted between ΔPC/ΔT and APACHE-Ⅱ score (p = 0.0648). The ΔPC/ΔT associated with the best discrimination between survivors and nonsurvivors was 20.57 × 109/L due to the cutoff with optimal Youden index (0.453). By multiple logistic regression, ΔPC/ΔT < 20.57 × 109/L was one of the prognostic predictors of 30-day mortality. Furthermore, Kaplan-Meier estimates of hospital survival according to the size of ΔPC/ΔT revealed that a blunted increase with ΔPC/ΔT < 20.57 × 109/L was associated with increased 30-day mortality. A blunted daily increase in PCs, especially ΔPC/ΔT < 20.57 × 109/L, is associated with increased 30-day mortality, which provides prognostic information for mortality risk assessment in severely burned patients.
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Affiliation(s)
- Xiaoqin Huang
- a Department of Burn and Plastic Surgery , Shanghai Jiao Tong University, School of Medicine, Rui Jin Hospital , Shanghai , China
| | - Feng Guo
- a Department of Burn and Plastic Surgery , Shanghai Jiao Tong University, School of Medicine, Rui Jin Hospital , Shanghai , China
| | - Zengding Zhou
- a Department of Burn and Plastic Surgery , Shanghai Jiao Tong University, School of Medicine, Rui Jin Hospital , Shanghai , China
| | - Mengling Chang
- a Department of Burn and Plastic Surgery , Shanghai Jiao Tong University, School of Medicine, Rui Jin Hospital , Shanghai , China
| | - Fei Wang
- b Department of Burns , the First Affiliated Hospital of Anhui Medical University , Hefei , Anhui , China
| | - Yi Dou
- a Department of Burn and Plastic Surgery , Shanghai Jiao Tong University, School of Medicine, Rui Jin Hospital , Shanghai , China
| | - Zhiyong Wang
- a Department of Burn and Plastic Surgery , Shanghai Jiao Tong University, School of Medicine, Rui Jin Hospital , Shanghai , China
| | - Jingning Huan
- a Department of Burn and Plastic Surgery , Shanghai Jiao Tong University, School of Medicine, Rui Jin Hospital , Shanghai , China
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Abstract
Platelet-rich plasma (PRP) is a fraction of blood plasma with a platelet concentration above baseline. After activation of the platelets, growth factors are released, which are involved in wound-healing processes. Application of a multitude of growth factors seems to boost the healing process. In this review the authors provide a comprehensive overview of the many different aspects of PRP; this is followed by a short outline of the evidence for a wide range of applications and finally narrowing down to a more in-depth analysis of the literature on the potential use of PRP in burn treatment. The authors performed an extensive search on PRP and the different biological, as well as practical aspects for the different applications. Furthermore, we performed a systematic search on PRP in the treatment of burn wounds. A high variety exists in PRP products, procedures, and content. This makes interpretation and comparison of the evidence difficult. PRP has been reported to have beneficial effects on wound healing in different fields of surgery and in the treatment of acute, chronic, and diabetic wounds. Literature on the use of PRP in burns is scarce. Separate growth factors have shown beneficial results in the treatment of burns. Furthermore, an animal study and several case reports showed improved burn wound-healing time after the application of PRP. A deep dermal burn could benefit from PRP through its hemostatic antimicrobial abilities and the positive effects seen in wound healing. However, burn patients have an altered physiological state and it is unknown how this may affect platelet function and quality. Furthermore, the effect of PRP on scarring has not been evaluated properly. Future research is needed to elucidate the role of PRP in the treatment of burns.
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Marck RE, Montagne HL, Tuinebreijer WE, Breederveld RS. Time course of thrombocytes in burn patients and its predictive value for outcome. Burns 2013; 39:714-22. [PMID: 23490002 DOI: 10.1016/j.burns.2013.01.015] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Revised: 01/21/2013] [Accepted: 01/22/2013] [Indexed: 10/27/2022]
Abstract
Thrombocytopenia is common in trauma and critically ill patients and is associated with a poor outcomes. The objective of this retrospective study was to investigate the course of thrombocyte concentration changes in burn patients, the influences of various factors on this course, and a possible predictive value of thrombocyte counts on outcome in 244 patients admitted to our burn centre. Their thrombocyte counts were obtained until 50 days after burn. Data on patient demographics, total percentage burned surface area (%TBSA), sepsis and mortality were collected. Multilevel multivariable analysis was performed to investigate the influence of the variables on the platelet course. Cox regression analysis was performed to analyse the predictive value of the variables for mortality. A distinct pattern of thrombocyte counts was observed, with a nadir at day 3 followed by a peak at day 15 and a temporary thrombocytosis. %TBSA and age (p<0.05) influence this course. The mean thrombocyte course of septic and non-surviving patients depicts a significant lower nadir. Furthermore, higher age, %TBSA and low thrombocyte counts at the peak are predictive for 50 day mortality (p<0.05). Platelets follow a distinct course after burn, influenced by %TBSA and age. These factors and a low thrombocyte peak count predict mortality.
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Lapchak PH, Kannan L, Ioannou A, Rani P, Karian P, Dalle Lucca JJ, Tsokos GC. Platelets orchestrate remote tissue damage after mesenteric ischemia-reperfusion. Am J Physiol Gastrointest Liver Physiol 2012; 302:G888-97. [PMID: 22301111 DOI: 10.1152/ajpgi.00499.2011] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Ischemia-reperfusion (I/R) injury is a leading cause of morbidity and mortality. A functional role for platelets in tissue damage after mesenteric I/R is largely unknown. The hypothesis that mesenteric I/R local and remote injury are platelet dependent was tested. Using a murine mesenteric I/R model, we demonstrate that platelets orchestrate remote lung tissue damage that follows mesenteric I/R injury and also contribute, albeit to a lesser degree, to local villi damage. While lung damage is delayed compared with villi damage, it increased over time and was characterized by accumulation of platelets in the pulmonary vasculature early, followed by alveolar capillaries and extravasation into the pulmonary space. Both villi and lung tissues displayed complement deposition. We demonstrate that villi and lung damage are reduced in mice made platelet deficient before I/R injury and that platelet transfusion into previously platelet-depleted mice before I/R increased both villi and lung tissue damage. Increased C3 deposition accompanied platelet sequestration in the lung, which was mostly absent in platelet-depleted mice. In contrast, C3 deposition was only minimally reduced on villi of platelet-depleted mice. Our findings position platelets alongside complement as a significant early upstream component that orchestrates remote lung tissue damage after mesenteric I/R and strongly suggest that reperfusion injury mitigating modalities should consider the contribution of platelets.
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Affiliation(s)
- Peter H Lapchak
- Rheumatology Division, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA 02115, USA
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Sio SWS, Puthia MK, Lu J, Moochhala S, Bhatia M. The neuropeptide substance P is a critical mediator of burn-induced acute lung injury. THE JOURNAL OF IMMUNOLOGY 2008; 180:8333-41. [PMID: 18523300 DOI: 10.4049/jimmunol.180.12.8333] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The classical tachykinin substance P (SP) has numerous potent neuroimmunomodulatory effects on all kinds of airway functions. Belonging to a class of neuromediators targeting not only residential cells but also inflammatory cells, studying SP provides important information on the bidirectional linkage between how neural function affects inflammatory events and, in turn, how inflammatory responses alter neural activity. Therefore, this study aimed to investigate the effect of local burn injury on inducing distant organ pulmonary SP release and its relevance to lung injury. Our results show that burn injury in male BALB/c mice subjected to 30% total body surface area full thickness burn augments significant production of SP, preprotachykinin-A gene expression, which encodes for SP, and biological activity of SP-neurokinin-1 receptor (NK1R) signaling. Furthermore, the enhanced SP-NK1R response correlates with exacerbated lung damage after burn as evidenced by increased microvascular permeability, edema, and neutrophil accumulation. The development of heightened inflammation and lung damage was observed along with increased proinflammatory IL-1beta, TNF-alpha, and IL-6 mRNA and protein production after injury in lung. Chemokines MIP-2 and MIP-1alpha were markedly increased, suggesting the active role of SP-induced chemoattractants production in trafficking inflammatory cells. More importantly, administration of L703606, a specific NK1R antagonist, 1 h before burn injury significantly disrupted the SP-NK1R signaling and reversed pulmonary inflammation and injury. The present findings show for the first time the role of SP in contributing to exaggerated pulmonary inflammatory damage after burn injury via activation of NK1R signaling.
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Fujimi S, MacConmara MP, Maung AA, Zang Y, Mannick JA, Lederer JA, Lapchak PH. Platelet depletion in mice increases mortality after thermal injury. Blood 2006; 107:4399-406. [PMID: 16467203 PMCID: PMC1895793 DOI: 10.1182/blood-2005-09-3776] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Platelets play a fundamental role in maintaining hemostasis and have been shown to participate in innate and adaptive immunity. However, the role of platelets in the immune response to injury remains undefined. We tested the importance of platelets in the host response to serious injury in a newly developed platelet-deficient mouse model. Wild-type and platelet-depleted C57BL/6J mice underwent a 25% full-thickness total body surface area thermal or sham injury. Platelet-deficient mice showed survival of 51% at 48 hours after injury compared with 94% to 100% survival in experimental control mice (P < .001). Necropsy and histology ruled out hemorrhage and hypovolemia as causes of death. Percentages of peripheral blood monocytes (P < .01) and neutrophils (P < .05) were increased between 36 and 48 hours after thermal injury in platelet-deficient mice compared with control mice. Plasma levels of TNFalpha (P < .001), IL-6 (P < .001), and MCP-1 (P < .05) were also elevated by 24 hours whereas levels of TGFbeta(1) were reduced between 24 and 36 hours following injury in platelet-depleted mice (P < .001) compared with control mice. Our findings demonstrate for the first time that platelets play a critical protective role during the host response to injury. Moreover, our findings suggest that platelets and, more importantly, platelet-derived TGFbeta(1) modulate the systemic inflammatory response occurring after injury.
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Affiliation(s)
- Satoshi Fujimi
- Julian and Eunice Cohen Laboratory for Surgical Research, Department of Surgery, Brigham and Women's Hospital, Boston, MA 02115, USA
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