Early coagulation changes as predictors of adverse outcomes in patients with severe burn and inhalation injuries

Background: Disorders of the coagulation pathway are triggered in patients with severe burn and inhalation injuries in the early stages. There are multiple early coagulation indices identified to correlate with adverse outcomes. Method: A retrospective analysis of patients with severe burn and inhalation injuries from 12 centers in mainland China was performed to identify early changed coagulation indices with predictive value associated with four major 28-day adverse outcomes (death, anticoagulation, mechanical ventilation, continuous renal replacement therapy) by logistic regression. The optimal cut-off value was also determined by Youden's index. Results: A total of 433 patients with severe burn and inhalation injuries were included in the study. Activated partial thromboplastin time (APTT) was found to be a risk factor for death, anticoagulation and continuous renal replacement therapy outcomes, while D-dimer was a risk factor for death and mechanical ventilation outcomes. Compared with previous definitions of coagulopathy, the occurrence of adverse outcomes was well predicted by both APTT and D-dimer. Patients were divided into high-risk and low-risk coagulopathy based on APTT and Ddimer cutoff values, with high-risk coagulopathy being an independent risk factor for death. Age, TBSA, lactate level, and pre-hospital infusion volume were identified as independent influencing factors on high-risk coagulopathy. Conclusion: The coagulation indices APTT and D-dimer in the early post-hospitalization period have a good early warning effect in the severe burn and inhalation injuries population, by which early screening to identify highrisk coagulopathies can be performed and targeted interventions can be implemented.