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Assessing Factor V Antigen and Degradation Products in Burn and Trauma Patients.

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Citation: Journal of Surgical Research. 274:169-177, 2022 06.Journal of Surgical Research. 274:169-177, 2022 Jun.PMID: 35180493Institution: MedStar Health Research Institute | MedStar Washington Hospital CenterDepartment: Firefighters' Burn and Surgical Research Laboratory | MedStar General Surgery Residency | MedStar Georgetown University Hospital/MedStar Washington Hospital Center | Surgery/Burn ServicesForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Blood Coagulation Disorders | *Burns | Burns/co [Complications] | Factor V/me [Metabolism] | Factor Va/me [Metabolism] | Humans | Injury Severity ScoreYear: 2022 ISSN:

0022-4804

Name of journal: The Journal of surgical researchAbstract: 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).All authors: Bourne DE, Bravo MC, Brummel-Ziedins KE, Carney BC, Freeman K, Kaye MD, Keyloun JW, Le TD, Mann KG, Orfeo T, Pusateri AE, Shupp JW, SYSCOT Study GroupOriginally published: Journal of Surgical Research. 274:169-177, 2022 Feb 15.Fiscal year: FY2022 Digital Object Identifier:

https://dx.doi.org/10.1016/j.jss.2021.12.049

Date added to catalog: 2022-03-17

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Item type	Current library	Collection	Call number	Status	Date due	Barcode
Journal Article	MedStar Authors Catalog	Article	35180493	Available		35180493

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).

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