| Background:Abnormal coagulation function is closely related to the prognosis of many diseases.Severe burn patients often have changes in coagulation indicators and platelet count at the early stage of admission.The purpose of this study was to observe the relationship between early coagulation indexes and platelet count changes and prognosis of severe burn patients of different ages,and to determine whether the changes of early coagulation indexes can provide guidance for the changes of severe burn patients of different ages.Method:The clinical data of adult severe burn patients admitted to Jiangxi Burn Center from December 2016 to December 2021 were retrospectively analyzed,and the general data of the patients were recorded.The patients were divided into two groups according to their age,18-49 years old group and ≥50 years old group.Each age group was grouped again according to the prognosis(death,survival)within 28 days of burn and burn area(the total area of burns≥50%TBSA,30%≤ the total area of burns < 50%),and the d-dimer,PT,INR,APTT,FIB,TT and platelet counts of each group within 1 week of admission were counted.By comparing the coagulation index and platelet count of the two groups in different age and between the two groups,the clinical guiding significance was obtained.Results:(1)General information: According to inclusion and exclusion criteria,87 adult patients with severe burns were eventually included.According to different age groups,patients were divided into 18-49 years old group and ≥50 years old group,34 cases in ≥50 years old group and 53 cases in 18-49 years old group.There were no significant differences in gender,respiratory tract injury,mechanical ventilation,time from injury to admission,total surface area of burned body,area of ⅲ degree burn and vital signs at admission(P > 0.05).(2)Comparison of coagulation indexes and platelets in different prognostic groups at different ages:(1)Comparison between the death group aged ≥50 and the death group aged 18-49: There was no significant statistical difference between the two groups in the early coagulation index and platelet count(P>0.05).(2)Comparison between the ≥50 years old survival group and the 18-49 years old survival group: on the first day of admission,FIB in the ≥50 years old survival group was significantly higher than that in the 18-49 years old survival group,and the difference was statistically significant(P < 0.05).On the fifth day of admission,INR was significantly higher than that of the 18-49 years old survival group,the difference was statistically significant(P < 0.05),and the remaining indicators did not have a significant difference between the two groups(P>0.05).(3)Comparison of coagulation indices and platelets in different burn area groups of different age groups:(1)When the total burn area ≥ 50%,the D-dimer was higher than that of the 18-49 age group at day 3 of the ≥50-year-old group,and the difference was statistically significant(P<0.05),and the remaining indicators did not have significant differences between the two groups(P>0.05).(2)When 30%≤ the total area of burns < 50%,the PT of the ≥ 50-year-old group was higher than that of the 18-49 age group on day 3,and the difference was statistically significant(P<0.05);On day 5,the TT was higher than that of the 18-49 age group,and the difference was statistically significant(P<0.05),and the remaining indicators did not have a significant difference between the two groups(P>0.05).(4)In severe burn patients aged 18-49 years,the blood coagulation index and platelet of the death group and the survival group were compared as follows:(1)On day 1,5 and 7,the PT,INR and TT of the death group were higher than those of the survival group,and the differences were statistically significant(P < 0.05).On day 1and 3,APTT in death group was higher than that in survival group,and the difference was statistically significant(P < 0.05).On day 5 and 7,FIB in death group was lower than that in survival group,and the difference was statistically significant(P < 0.05).On day 3,5 and 7,PLT count in death group was lower than that in survival group,the difference was statistically significant(P < 0.05),but there was no significant difference in other indicators(P > 0.05).(2)Logistic univariate regression analysis showed that total burn area(TBSA%),Ⅲ degree burn area(TBSA%),PT,INR and TT on day 1,APTT,TT,platelet count and INR on day 3,INR,FIB and platelet count on day 5,INR,FIB,platelet count on the 7th day were correlated with the prognosis of severe burn patients aged 18-49 years within 28 days after injury(see Table 3.5).Logistics multifactor analysis on the 1st day after admission showed that no independent death factor was found for severe burn patients aged 18-49 years(P <0.05).(5)In severe burn patients aged ≥50 years,the coagulation index and platelet of the death group and the survival group were compared as follows:(1)On day 1,the D-dimer,PT and INR of the death group were higher than those of the survival group,the differences were statistically significant(P < 0.05);On day 3,FIB in the death group was lower than that in the survival group,with statistical significance(P <0.05).On day 3,5 and 7,PLT count in death group was lower than that in survival group,the difference was statistically significant(P < 0.05),but there was no significant difference in other indicators(P > 0.05).(2)According to univariate logistics analysis,the total burn area(TBSA%),third-degree burn area(TBSA%),D-dimer,platelet count on the 3rd,5th and 7th day of admission were correlated with the prognosis of severe burn patients aged ≥50 years within 28 days after injury(see Table 3.8).Logistic multifactor regression analysis on the first day of admission showed that D-dimer on the first day of admission was an independent risk factor for28-day prognosis and death in severe burn patients aged ≥50 years.(3)The optimal threshold of D-dimer for predicting the prognosis and death of ≥50 years old severe burn patients on the first day of admission was 9.68 ?/m L.The sensitivity,specificity,Youden index and area under the ROC curve were 50%,100%,0.5 and 0.738respectively(95% confidence interval was 0.530-0.945,P = 0.03).Conclusion:Early coagulation in patients with severe burns is characterized by low coagulation with thrombocytopenia,among which patients with severe burns ≥ 50 years of age are more likely to have procoagulation impairment.Individualized interventions for coagulation function in patients of different ages may help improve prognosis in patients with severe burns. |
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