Early protein C activation is reflective of burn injury severity and plays a critical role in inflammatory burden and patient outcomes

Zhao, Ruilong; Lang, Thomas Charles; Kim, Albert; Wijewardena, Aruna; Vandervord, John; McGrath, Rachel T.; Fulcher, Gregory; Xue, Meilang; Jackson, Christopher J.

doi:10.1016/j.burns.2021.03.004

Cited by 3 publications

(1 citation statement)

References 72 publications

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“…Since data on Factor V in burn patients are limited, indirect conclusions can be drawn from studies of Protein C in this population. The endogenous anticoagulant activated Protein C (aPC) is a serine protease that inactivates several factors in the coagulation cascade, including factor V. Activated protein C increases from day 3 following a severe burn injury [48]. Based on these findings, we would expect a decrease in Factor V levels which is consistent with our results.…”

Section: Coagulation Factorssupporting

confidence: 88%

It’s written in the Clot: Rotational Thromboelastometry in Severe Burn Injury – A Holistic Coagulation Assessment

Nikolaidou¹,

Lazaridou²,

Iasonidou³

et al. 2023

Preprint

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The alterations of coagulation status in patients with Severe Burn Injury are associated with serious complications, increased morbidity and mortality. This study aims to compare Rotational Thromboelastometry(ROTEM)–a Viscoelastic Coagulation Assays(VCAs) with Conventional Coagulation Assays(CCAs) including Prothrombin time(PT), Activated Partial Thromboplastin time(aPTT), International normalized ratio(INR), Complete Blood Count(CBC) and Coagulation Factors during the early five post- burn days in Survivors and Non- Survivors with Severe Burn Injury in order to correlate these results with Burn Coagulopathy and Prognosis. Seventeen Sur-vivors and ten Non- Survivors, with a mean Total Burn Surface Area(TBSA) of 33,78% were in-cluded in our study. Even though CCAs measurements were abnormal, they were unable to detect overall burn patients’ coagulopathy. On the contrary, VCAs from day 2 to day 5 took pathological values, especially for Non- survivors. Those changes were underlined through pathological values of Coagulation Factors. As a result, CCAs were considered poor indicators of coagulation status in burn injury, whereas VCAs were more accurate in demonstrating coagulation alterations from the early post- burn period and detecting patients in greater risk of mortality. These advantages of VCAs could be used for timely intervention in high risk patients and for the guidance of blood product transfusions.

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Section: Coagulation Factorssupporting

confidence: 88%

It’s written in the Clot: Rotational Thromboelastometry in Severe Burn Injury – A Holistic Coagulation Assessment

Nikolaidou¹,

Lazaridou²,

Iasonidou³

et al. 2023

Preprint

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Monocyte Anisocytosis Changes in Patients After Major Burn Injuries

Nazemidashtarjandi,

Muldur,

Supple

et al. 2024

Journal of Burn Care &Amp; Research

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The recovery of patients after severe burns is a long and complex process. Recently, genomic analysis of white blood cells from burn and trauma patients revealed excessive and prolonged innate immune activation in patients with complicated outcomes. However, translating this knowledge into practical biomarkers has not been possible yet. Although several biomarkers for monitoring burn patients have been proposed, their ability to accurately distinguish between inflammation stemming from initial tissue destruction, infections, and organ failure complications is limited. Here, we focused on monocytes, critical innate immune cells in the response to burn injured tissues. We measured the monocyte anisocytosis (quantified as monocyte distribution width, MDW, a recently emerged marker of sepsis) throughout the recovery of patients from the time of burn injury until the end of the hospital stay. We observed that MDW increases in patients during the first week after major burns. Among the patients with major burns who survive, MDW starts decreasing in the second week and normalizes by the end of the hospital stay. The duration of hospital stay appears to be proportional to how fast MDW decreases during the second week after the injury. We also found that MDW decreases significantly in most patients after excision and debridement surgeries but not after allo- and auto-graft surgeries. Moreover, high MDW values correlated with a higher rate of positive microbiology blood culture samples and respiratory infections. These findings underscore the importance of monitoring MDW as a potential biomarker for the risk of complications during burn patient recovery.

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Epidermal Protein C Levels Correspond to Local Injury Severity and Increased Clinical Support in Burn Patients

Zhao

Wang

Lang

et al. 2021

EBJ

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The protein C (PC) system has proven to be a crucial cascade in systemic inflammatory and coagulopathic disorders such as severe sepsis and, more recently, in severe burns. We aimed to conflate our recent systemic findings with further investigations in the local tissue effects of a severe burn injury on the expression of PC and its main receptor endothelial protein C receptor (EPCR). Of the 86 patients enrolled in our recent study, 34 consented to biopsies of both normal and burn edge tissue. These were examined histologically and immunostained for PC, EPCR, and CD68. The burn samples expressed lower PC (p = 0.0027) and higher EPCR (p = 0.0253) than the normal samples in a histological severity-dependent manner. There was also a negative association between PC expression and CD68 positive macrophage infiltration (τb = −0.214, p = 0.020), which was expectedly higher in burn edge samples (p < 0.0005). Interestingly, while there were no correlations between tissue and plasma PC or EPCR, local PC expression was also prognostic of our previously established outcome of a patient requiring increased medical support (OR 0.217 (95%CI 0.052 to 0.901), p = 0.035). The results suggest that local PC cascade changes from a burn injury may be a separate process to the systemic effects and that the local levels may provide useful information in addition to the diagnostic and prognostic abilities we previously found in the circulating PC system.

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Early protein C activation is reflective of burn injury severity and plays a critical role in inflammatory burden and patient outcomes

Cited by 3 publications

References 72 publications

It’s written in the Clot: Rotational Thromboelastometry in Severe Burn Injury – A Holistic Coagulation Assessment

It’s written in the Clot: Rotational Thromboelastometry in Severe Burn Injury – A Holistic Coagulation Assessment

Monocyte Anisocytosis Changes in Patients After Major Burn Injuries

Epidermal Protein C Levels Correspond to Local Injury Severity and Increased Clinical Support in Burn Patients

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