It Is Written in the Clot: Coagulation Assessment in Severe Burn Injury

TL;DR

This study compares different coagulation tests in severe burn patients and finds that viscoelastic assays are more effective than traditional tests in predicting coagulopathy and mortality risk.

Contribution

The study demonstrates that viscoelastic coagulation assays (VCAs) are more sensitive than conventional coagulation assays in detecting coagulopathy in severe burn patients.

Findings

Conventional coagulation assays (CCAs) failed to detect coagulopathy in severe burn patients.

Viscoelastic coagulation assays (VCAs) showed increased FIBTEM MCF values in non-survivors from day 2 onwards.

Abnormal VCAs parameters at day 2 and day 5 correlated with higher mortality risk in burn patients.

Abstract

Background: Coagulopathy in severe burn injury is associated with complications and mortality. Methods: We compared 3 tests (EXTEM, INTEM, FIBTEM) of rotational thromboelastometry (ROTEM), a viscoelastic coagulation assay (VCA), with conventional coagulation assays (CCAs), fibrinogen, d-dimers and coagulation factors during the five post-burn days in survivors and non-survivors with severe burn injury, in order to correlate the results with burn coagulopathy and prognosis. Results: Seventeen survivors and ten non-survivors, with mean total burn surface area of 33.78% were included. CCAs measurements were abnormal, but unable to detect coagulopathy. At day 2, D-dimers and fibrinogen levels were statistically augmented for non-survivors. Regarding VCAs, FIBTEM MCF increased for non-survivors at day 2 and remained increased for the whole post-burn period. Furthermore, FIBTEM A10 and A20 at day 2 and EXTEM A10, EXTEM A20, EXTEM MCF, and EXTEM CFT at day 5 took abnormal values for the same group (p < 0.05). These changes were underlined through abnormal measurements of coagulation factors. Conclusions:CCAs are poor indicators of coagulation status in burn injury, whereas VCAs are more sensitive markers, demonstrating coagulopathy and patients at greater risk of mortality.