Retrospective study on the characteristics and alarming value of coagulation in adult patients with extensively severe burn at shock stage

Objective: To study the coagulation characteristics and alarming value of adult patients with extensively severe burn at shock stage. Methods: Retrospective analysis was performed on medical records of 37 adult patients with extensively severe burn who admitted to Intensive Care Unit of Burns and Trauma of the First Affiliated Hospital of Navy Medical University from January 2014 to December 2019 and met the inclusion criteria. The patients were divided into survival group (n=23, 17 males and 6 females, aged 41(31, 51) years) and death group (n=14, 11 males and 3 females, aged 50 (43, 58) years) according to the prognosis of 60 d after burn. Basic data of two patients and routine coagulation index during shock period including prothrombin time (PT), thrombin time (TT), activated partial thromboplastin time (APTT), D-Dimer (DD), fibrinogen degradation products (FDP), fibrinogen (FIB) , platelet(PLT), and international normalized ratio (INR) were recorded. Data were statistically analyzed with Wilcoxon rank sum test and Fisher exact probability method, prognosis-related factors was analyzed with single factor and multivariate logistic regression analysis (α selected=0.05, α excluded=0.1) and receiver's operating characteristic (ROC) curve analysis were established to screen out risk factors. All patients were grouped into high score group and low score group according to the cut-off value, Kaplan-Meier method was used for survival analysis and Log-rank test was performed between the two groups. Results: Total burn area (TBSA) of patients in death group was larger than that in survival group (Z=2.980, P<0.01) , while the other index between the two groups were close. Compared with those in survival group (16.10(14.30, 16.90), 40.80(36.20, 42.80), 1.30(1.10, 1.40)), PT(18.70(16.30, 22.70)), APTT(46.45(41.00, 57.10)) and INR (1.55(1.30,1.96)) were significantly increased of patients in death group (Z=2.540, 2.330, 2.300, P<0.05). Single factor logistic regression analysis showed TBSA, PT, and APTT were factors related to death for 60 d after burn (odds ratio (OR) =1.190, 1.214, 1.109, 95% confidence interval (CI) =1.053-1.346, 1.008-1.461, 1.012-1.215, P<0.05 or P<0.01). FDP and INR were potential factors related to death for 60 d after injury (OR=1.040 and 4.559, 95% CI =0.998-1.083 and 0.918-22.641, P<0.1). Multivariate logistic stepwise regression was used to build models of APTT+FDP+TBSA and APTT+FDP. ROC analysis showed area under the curve (AUC) of APTT+FDP+TBSA model score was 94.41% (87.33%-100%) and its prediction accuracy was higher than AUC of APTT+FDP model score (84.32% (71.31%~97.33%) ). Cut-off value was -0.879 with sensitivity of 100%(100%-100%) and specificity of 87%(74%-100%). Survival ratio of patients in high score group with Cut-off value more than -0.879 4 was significantly lower than that in low score group with Cut-off value lower than -0.879 4, X(2)=27.090, P<0.01. Conclusions: The coagulation characteristics in adult patients with extensively severe burn during shock stage is procoagulant and hemostatic dysfunction accompanied by enhanced fibrinolytic activity. The risk of death is significantly increased in adult patients with extensively severe burn with APTT+FDP+TBSA model score more than -0.8794.