Early correction of coagulopathy reduces the 28day mortality in adult patients with largearea burns.

OBJECTIVES

Coagulation dysfunction caused by large-area burns is an independent risk factor for the 28-day mortality of adult patients. However, whether early (48 hours after admission) correction of coagulopathy can reduce the 28-day mortality of adult patients with large-area burns has not been clarified. The purpose of this study was to investigate the effect of early correction of coagulopathy on the 28-day mortality in the adult patients with large-area burns.

METHODS

Medical records of burn patients with blood transfusion who were hospitalized in the Department of Burn, First Affiliated Hospital of Nanchang University from April 2014 to July 2019 were retrieved. Among them, 573 adult patients with large-area burns were selected as the research subjects. The patients were divided into an experimental group (patients had early rectification of coagulation dysfunction, =290) and a control group (patients without early rectification of coagulation dysfunction, =283). The basic clinical data and prognostic indicators of the 2 groups were compared. Logistic univariate regression analysis was used to screen the influential factors of 28-day mortality in adult patients with large-area burns, and further logistic multivariate regression analysis was carried out to obtain independent risk factors and protective factors. Kaplan-Meier method was used to draw the survival curve for the 2 groups of patients, and log-rank test was used.

RESULTS

The differences of the burn area/the total body surface area (TBSA), III° burn area, 24-hour urine volume and rehydration volume, 48-hour fresh frozen plasma transfusion volume, and 48-hour activated partial thromboplastin time (APTT) between the 2 groups were statistically significant (all <0.05). The duration of mechanical ventilation in the experimental group was shorter than that in the control group, and the 28-day mortality in the experimental group was significantly lower than that in the control group (10% vs 24%, both <0.05). The results of logistic univariate regression analysis showed that burn area/TBSA, III° burn area, inhalation injury, length of hospital stay, mechanical ventilation time, 48-hour frozen plasma infusion, and 48-hour coagulation dysfunction correction were the influential factors of 28-day mortality of adult patients with large-area burns and coagulation dysfunction at admission (all <0.05). Logistic multivariate regression analysis showed that the burn area/TBSA (OR=1.058, 95% CI 0.921 to 1.214, =0.022) and III° burn area (OR=1.085, 95% CI 1.009 to 1.168, =0.027) were independent risk factors for 28-day mortality of adult patients with large-area burns, while 48-hour frozen plasma transfusion volume (OR=0.098, 95% CI 0.012 to 0.789, =0.029) and 48-hour coagulation dysfunction correction (OR=0.103, 95% CI 0.015 to 0.679, =0.018) were independent protective factors. Kaplan-Meier survival curve analysis showed that 28-day survival rates of the experimental group and the control group were 90% and 76%, respectively. The difference between them was statistically significant (χ=14.270, <0.001).

CONCLUSIONS

The burn area/TBSA and III° burn area are independent risk factors for 28-day mortality in adult patients with large-area burns. The 48-hour frozen plasma transfusion volume and 48-hour correction of coagulopathy are independent protective factors. Early correction of coagulation dysfunction is beneficial to reducing the 28-day mortality for the adult patients with large-area burns.