Assessing Factor V Antigen and Degradation Products in Burn and Trauma Patients.
Assessing Factor V Antigen and Degradation Products in Burn and Trauma Patients.
- 2022
CONCLUSIONS: Increasing traumatic injury severity is associated with decreased FV antigen levels, and a greater proportion of trauma patient samples exhibit proteolytically degraded FV fragments. These associations are not present in burns, suggesting that mechanisms underlying FV depletion in burn and nonburn trauma are not identical. Copyright ♭ 2022. Published by Elsevier Inc. INTRODUCTION: Proposed mechanisms of acute traumatic coagulopathy (ATC) include decreased clotting potential due to factor consumption and proteolytic inactivation of factor V (FV) and activated factor V (FVa) by activated protein C (aPC). The role of FV/FVa depletion or inactivation in burn-induced coagulopathy is not well characterized. This study evaluates FV dynamics following burn and nonburn trauma. METHODS: Burn and trauma patients were prospectively enrolled. Western blotting was performed on admission plasma to quantitate levels of FV antigen and to assess for aPC or other proteolytically derived FV/FVa degradation products. Statistical analysis was performed with Spearman's, Chi-square, Mann-Whitney U test, and logistic regression. RESULTS: Burn (n = 60) and trauma (n = 136) cohorts showed similar degrees of FV consumption with median FV levels of 76% versus 73% (P = 0.65) of normal, respectively. Percent total body surface area (TBSA) was not correlated with FV, nor were significant differences in median FV levels observed between low and high TBSA groups. The injury severity score (ISS) in trauma patients was inversely correlated with FV (rho = -0.26; P = 0.01) and ISS >= 25 was associated with a lower FV antigen level (64% versus. 93%; P = 0.009). The proportion of samples showing proteolysis-derived FV was greater in trauma than burn patients (42% versus. 16%; P = 0.0006).
English
0022-4804
10.1016/j.jss.2021.12.049 [doi] S0022-4804(22)00021-X [pii]
*Blood Coagulation Disorders
*Burns
Burns/co [Complications]
Factor V/me [Metabolism]
Factor Va/me [Metabolism]
Humans
Injury Severity Score
MedStar Health Research Institute
MedStar Washington Hospital Center
Firefighters' Burn and Surgical Research Laboratory
MedStar General Surgery Residency
MedStar Georgetown University Hospital/MedStar Washington Hospital Center
Surgery/Burn Services
Journal Article
CONCLUSIONS: Increasing traumatic injury severity is associated with decreased FV antigen levels, and a greater proportion of trauma patient samples exhibit proteolytically degraded FV fragments. These associations are not present in burns, suggesting that mechanisms underlying FV depletion in burn and nonburn trauma are not identical. Copyright ♭ 2022. Published by Elsevier Inc. INTRODUCTION: Proposed mechanisms of acute traumatic coagulopathy (ATC) include decreased clotting potential due to factor consumption and proteolytic inactivation of factor V (FV) and activated factor V (FVa) by activated protein C (aPC). The role of FV/FVa depletion or inactivation in burn-induced coagulopathy is not well characterized. This study evaluates FV dynamics following burn and nonburn trauma. METHODS: Burn and trauma patients were prospectively enrolled. Western blotting was performed on admission plasma to quantitate levels of FV antigen and to assess for aPC or other proteolytically derived FV/FVa degradation products. Statistical analysis was performed with Spearman's, Chi-square, Mann-Whitney U test, and logistic regression. RESULTS: Burn (n = 60) and trauma (n = 136) cohorts showed similar degrees of FV consumption with median FV levels of 76% versus 73% (P = 0.65) of normal, respectively. Percent total body surface area (TBSA) was not correlated with FV, nor were significant differences in median FV levels observed between low and high TBSA groups. The injury severity score (ISS) in trauma patients was inversely correlated with FV (rho = -0.26; P = 0.01) and ISS >= 25 was associated with a lower FV antigen level (64% versus. 93%; P = 0.009). The proportion of samples showing proteolysis-derived FV was greater in trauma than burn patients (42% versus. 16%; P = 0.0006).
English
0022-4804
10.1016/j.jss.2021.12.049 [doi] S0022-4804(22)00021-X [pii]
*Blood Coagulation Disorders
*Burns
Burns/co [Complications]
Factor V/me [Metabolism]
Factor Va/me [Metabolism]
Humans
Injury Severity Score
MedStar Health Research Institute
MedStar Washington Hospital Center
Firefighters' Burn and Surgical Research Laboratory
MedStar General Surgery Residency
MedStar Georgetown University Hospital/MedStar Washington Hospital Center
Surgery/Burn Services
Journal Article