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[Antithrombin III in burned children]
1Clinica Pediatrica, Università di Roma Tor Vergata, Roma, Italy.
Insights
Severe burn patients with low Antithrombin III (ATIII) levels face higher mortality. ATIII concentrate infusions improved plasma levels and microcirculation recovery in a pilot study.
Area of Science:
- Biomedical research
- Trauma surgery
- Critical care medicine
Background:
- Severe burns significantly impact hemostatic parameters and Antithrombin III (ATIII) levels.
- Understanding these changes is crucial for predicting survival and guiding treatment in pediatric burn patients.
Purpose of the Study:
- To investigate the relationship between haemostatic parameters, specifically Antithrombin III (ATIII) levels, and survival in severe burn patients.
- To evaluate the safety and efficacy of Antithrombin III (ATIII) concentrate infusions in improving outcomes for thermal injury patients.
Main Methods:
- Analysis of haemostatic parameters and ATIII levels in 50 pediatric severe burn admissions using statistical methods (Fisher exact test, chi square, logistic regression, discriminant analysis).
- A pilot study involving ATIII concentrate infusions every 8 hours for 72 hours in burn patients, compared to a control group.
Main Results:
- Total burned surface area was the best predictor of survival. ATIII levels showed a significant correlation with mortality (p=0.0005).
- ATIII concentrate infusions successfully raised plasma ATIII levels to 105%+/-20% compared to 50%+/-14% in controls (P < 0.001).
- Patients treated with ATIII concentrate experienced shorter microcirculation recovery times (P<0.02).
Conclusions:
- Low Antithrombin III (ATIII) levels are a significant predictor of mortality in severe burn patients.
- Antithrombin III (ATIII) concentrate infusions appear safe and effective in improving plasma levels and accelerating microcirculation recovery in thermal injury.
- Further research into ATIII management in burn care is warranted.
Abstract:
We studied haemostatic parameter and Antithrombin III (ATIII) level in 50 consecutive admissions for severe burns between 1990 to1994 to the Centro Grandi Ustionati Ospedale S. Eugenio, Rome. The criteria for inclusion in the study were age <16 years and the presence of major burns (extent of the burns >30 and second and third degree burns). Treatment consisted of initial fluid resuscitation and early excision and grafting of burn wounds and critical care support by a multidisciplinary team. Burn-related variables haemostatic values and the conditions of microcirculation were proposed and analysed with the help of Fisher exact test, chi square test, logistic regression and discriminant analysis. By the discriminant analysis, the coefficients of the standardized functions and the percentage of correctly classified individuals were calculated. The analysis showed total burned surface turned out to be the best predictor of survival. High discrimination efficiency was observed for age, weight, burn type (flame, scald contact chemical electrical). By the logistic regression, the total burned surface confirmed to be the best predictor of survival and between the haemostatic variables ATIII give a significant value (p=0.0244). Moreover, it is noteworthy that ATIII level at the onset of the disease gives a significant correlation with mortality (p=0.0005). The Fisher test showed a significant association between ATIII level and death (p=0.0005). This was confirmed by the chi square test (p=0.00027). Considering the AT deficiency in patients with thermal injuries, we conducted a pilot study to assess AT concentrate infusions for safety and efficacy in thermal injury. The patients received AT concentrate infusions every 8 hours to raise the plasma level to 100 % in the first 72 hours after injury and were compared with control patients with burns. Day4 levels were 105%+/-20% in patients treated with AT patients versus 50%+/-14% in the control patients (P < 0.001). In the group treated with AT the time to microcirculation recovery was shorter (P<0.02).