Koami Hiroyuki, Sakamoto Yuichiro, Matsuoka Ayaka, Shinada Kota
Department of Emergency and Critical Care Medicine, Saga University, Saga, JPN.
Department of Emergency and Critical Care Medicine, Saga University Hospital, Saga, JPN.
Cureus. 2024 Feb 19;16(2):e54489. doi: 10.7759/cureus.54489. eCollection 2024 Feb.
Background In this study, we aimed to analyze the association between the burn index (BI) and burn-induced coagulopathy. Methods Adult burn patients transported to our emergency department who underwent rotational thromboelastometry (ROTEM) between April 1, 2013, and December 31, 2021, were enrolled in this study. The patients were categorized into two groups based on burn severity. Severe burns were defined as BI scores of > 15. Patient demographics, clinical variables of burns, standard laboratory test data, ROTEM data, and clinical outcomes of both groups were evaluated. In addition, the correlation between severe burns and significant variables was evaluated using a univariate analysis. Results Seven patients were enrolled and categorized into the severe (n = 2) and control (n = 5) groups. The severe group had a significantly worse consciousness level and higher mortality rate and showed higher tendencies of burn severity and clinical severity scores. Disseminated intravascular coagulation was confirmed in one patient. All ROTEM variables in the severe group regarding clot firmness in the extrinsic coagulation cascade (EXTEM) and fibrinogen-specific coagulation cascade (FIBTEM) showed a decreasing tendency as compared to those in the control group. Moreover, correlation analyses revealed strong correlations between the BI and clot firmness (rho = -0.946 to -0.721). Conclusions Severe BI was strongly associated with decreased blood clot firmness in EXTEM, FIBTEM, and ROTEM. Future research using viscoelastic devices may provide new possibilities for the treatment of severe burns.
背景 在本研究中，我们旨在分析烧伤指数（BI）与烧伤诱导的凝血病之间的关联。方法 纳入2013年4月1日至2021年12月31日期间转运至我院急诊科并接受旋转血栓弹力图（ROTEM）检查的成年烧伤患者。根据烧伤严重程度将患者分为两组。严重烧伤定义为BI评分>15。评估两组患者的人口统计学资料、烧伤临床变量、标准实验室检查数据、ROTEM数据及临床结局。此外，采用单因素分析评估严重烧伤与显著变量之间的相关性。结果 共纳入7例患者，分为严重烧伤组（n = 2）和对照组（n = 5）。严重烧伤组意识水平明显更差，死亡率更高，烧伤严重程度和临床严重程度评分更高。1例患者确诊为弥散性血管内凝血。与对照组相比，严重烧伤组在外源性凝血级联反应（EXTEM）和纤维蛋白原特异性凝血级联反应（FIBTEM）中所有关于血凝块硬度的ROTEM变量均呈下降趋势。此外，相关性分析显示BI与血凝块硬度之间存在强相关性（rho = -0.946至-0.721）。结论 严重BI与EXTEM、FIBTEM和ROTEM中血凝块硬度降低密切相关。未来使用粘弹性装置的研究可能为严重烧伤的治疗提供新的可能性。
