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

Author

Keyloun, John W, Le, Tuan D, Orfeo, Thomas, Brummel-Ziedins, Kathleen E, Bravo, Maria C, Kaye, Matthew D, Bourne, Dana E, Carney, Bonnie C, Freeman, Kalev, Mann, Kenneth G, Pusateri, Anthony E, Shupp, Jeffrey W, and SYSCOT Study Group

Subjects
SYSCOT Study Group, Humans, Blood Coagulation Disorders, Burns, Factor V, Factor Va, Injury Severity Score, Coagulopathy, Protein C, Trauma, Physical Injury - Accidents and Adverse Effects, Clinical Research, Clinical Sciences, Surgery
Abstract

IntroductionProposed 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.MethodsBurn 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.ResultsBurn (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 (ρ = -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).ConclusionsIncreasing 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.

Published
2022

6. Inhalation Injury is Associated with Endotheliopathy and Abnormal Fibrinolytic Phenotypes in Burn Patients: A Cohort Study

Author

Keyloun, John W, Le, Tuan D, Brummel-Ziedins, Kathleen E, Mclawhorn, Melissa M, Bravo, Maria C, Orfeo, Thomas, Johnson, Laura S, Moffatt, Lauren T, Pusateri, Anthony E, Shupp, Jeffrey W, McLawhorn, Melissa M, Callcut, Rachael A, Cohen, Mitchell J, Petzold, Linda R, Varner, Jeffrey D, Bravo, Maria Cristina, Freeman, Kalev, Mann, Kenneth G, Gautam, Aarti, Hammamieh, Rasha, and Jett, Marti

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Hematology, Physical Injury - Accidents and Adverse Effects, Clinical Research, Good Health and Well Being, Burns, Cohort Studies, Female, Humans, Male, Phenotype, Retrospective Studies, Thrombelastography, SYSCOT Study Group, Emergency & Critical Care Medicine, Clinical sciences, Allied health and rehabilitation science, Nursing
Abstract

Burn injury is associated with endothelial dysfunction and coagulopathy and concomitant inhalation injury (IHI) increases morbidity and mortality. The aim of this work is to identify associations between IHI, coagulation homeostasis, vascular endothelium, and clinical outcomes in burn patients. One hundred and twelve patients presenting to a regional burn center were included in this retrospective cohort study. Whole blood was collected at set intervals from admission through 24 hours and underwent viscoelastic assay with rapid thromboelastography (rTEG). Syndecan-1 (SDC-1) on admission was quantified by ELISA. Patients were grouped by the presence (n = 28) or absence (n = 84) of concomitant IHI and rTEG parameters, fibrinolytic phenotypes, SDC-1, and clinical outcomes were compared. Of the 112 thermally injured patients, 28 (25%) had IHI. Most patients were male (68.8%) with a median age of 40 (interquartile range, 29-57) years. Patients with IHI had higher overall mortality (42.68% vs 8.3%; P < .0001). rTEG LY30 was lower in patients with IHI at hours 4 and 12 (P < .05). There was a pattern of increased abnormal fibrinolytic phenotypes among IHI patients. There was a greater proportion of IHI patients with endotheliopathy (SDC-1 > 34 ng/ml) (64.7% vs 26.4%; P = .008). There was a pattern of increased mortality among patients with IHI and endotheliopathy (0% vs 72.7%; P = .004). Significant differences between patients with and without IHI were found in measures assessing fibrinolytic potential and endotheliopathy. Mortality was associated with abnormal fibrinolysis, endotheliopathy, and IHI. However, the extent to which IHI-associated dysfunction is independent of TBSA burn size remains to be elucidated.

Published
2022

7. Comparison of Rapid-, Kaolin-, and Native-TEG Parameters in Burn Patient Cohorts With Acute Burn-induced Coagulopathy and Abnormal Fibrinolytic Function

Author

Keyloun, John W, Le, Tuan D, Moffatt, Lauren T, Orfeo, Thomas, McLawhorn, Melissa M, Bravo, Maria-Cristina, Tejiram, Shawn, Bravo, Maria-Cristina, Brummel-Ziedins, Kathleen E, Callcut, Rachael A, Cohen, Mitchell J, Freeman, Kalev, Gautam, Aarti, Hammamieh, Rasha, Jett, Marti, McLawhorn, Melissa M, Moffatt, Lauren T, Petzold, Linda R, Pusateri, Anthony E, Shupp, Jeffrey W, Varner, Jeffrey D, Shupp, Jeffrey W, and Pusateri, Anthony E

Published
2024
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12. Burn-Induced Coagulopathies: a Comprehensive Review

Author

Ball, Robert L, Keyloun, John W, Brummel-Ziedins, Kathleen, Orfeo, Thomas, Palmieri, Tina L, Johnson, Laura S, Moffatt, Lauren T, Pusateri, Anthony E, and Shupp, Jeffrey W

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Prevention, Physical Injury - Accidents and Adverse Effects, Aetiology, 2.1 Biological and endogenous factors, Blood Coagulation Disorders, Burns, Female, Fibrinolysis, Humans, Inflammation, Male, Clot dysfunction, coagulopathy, hemostasis, thermal injury, thrombosis, Emergency & Critical Care Medicine, Clinical sciences
Abstract

Burn-induced coagulopathy is not well understood, and consensus on diagnosis, prevention, and treatments are lacking. In this review, literature on burn-induced (and associated) coagulopathy is presented along with the current understanding of the effects of burn injury on the interactions among coagulation, fibrinolysis, and inflammation in the acute resuscitative phase and reconstructive phase of care. The role of conventional tests of coagulopathy and functional assays like thromboelastography or thromboelastometry will also be discussed. Finally, reported methods for the prevention and treatment of complications related to burn-induced coagulopathy will be reviewed.

Published
2020

25. Endothelial dysfunction is dampened by early administration of fresh frozen plasma in a rodent burn shock model

Author

Kelly, Edward J., Ziedins, Eriks E., Carney, Bonnie C., Moffatt, Lauren T., and Shupp, Jeffrey W.

Abstract

Endothelial dysfunction has been implicated in the pathogenesis of shock. Fresh frozen plasma is a promising potential therapy. This work utilizes a rodent burn shock model to examine the timing of FFP administration and its effects on glycocalyx and cytokine transcription.

Published
2024
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28. Initial Development and Analysis of a Context-Aware Burn Resuscitation Decision-Support Algorithm.

Author

Kao, Yi-Ming, Arabidarrehdor, Ghazal, Parajuli, Babita, Ziedins, Eriks E., McLawhorn, Melissa M., D'Orio, Cameron S., Oliver, Mary, Moffatt, Lauren, Mathew, Shane K., Kelly, Edward J., Carney, Bonnie C., Shupp, Jeffrey W., Burmeister, David M., and Hahn, Jin-Oh

Subjects
PULSE wave analysis, CARDIAC resuscitation, HEART injuries, BURN patients, SOCIAL networks
Abstract

Burn patients require high-volume intravenous resuscitation with the goal of restoring global tissue perfusion to make up for burn-induced loss of fluid from the vasculature. Clinical standards of burn resuscitation are predominantly based on urinary output, which is not context-aware because it is not a trustworthy indicator of tissue perfusion. This paper investigates the initial development and analysis of a context-aware decision-support algorithm for burn resuscitation. In this context, we hypothesized that the use of a more context-aware surrogate of tissue perfusion may enhance the efficacy of burn resuscitation in normalizing cardiac output. Toward this goal, we exploited the arterial pulse wave analysis to discover novel surrogates of cardiac output. Then, we developed the cardiac output-enabled burn resuscitation decision-support (CaRD) algorithm. Using experimental data collected from animals undergoing burn injury and resuscitation, we conducted an initial evaluation and analysis of the CaRD algorithm in comparison with the commercially available Burn NavigatorTM algorithm. Combining a surrogate of cardiac output with urinary output in the CaRD algorithm has the potential to improve the efficacy of burn resuscitation. However, the improvement achieved in this work was only marginal, which is likely due to the suboptimal tuning of the CaRD algorithm with the limited available dataset. In this way, the results showed both promise and challenges that are crucial to future algorithm development. [ABSTRACT FROM AUTHOR]

Published
2024
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32. Evaluating Real-World National and Regional Trends in Definitive Closure in U.S. Burn Care: A Survey of U.S. Burn Centers

Author

Carter, Jeffrey E, Amani, Hamed, Carter, Damien, Foster, Kevin N, Griswold, John A, Hickerson, William L, Holmes, James H, IV, Jones, Samuel, Khandelwal, Anjay, Kopari, Nicole, Litt, Jeffrey S, Savetamal, Alisa, Shupp, Jeffrey W, Sood, Rajiv, Ferrufino, Cheryl P, Vadagam, Pratyusha, Kowal, Stacey, Walsh, Tom, and Sparks, Jeremiah

Published
2022
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39. Automated Anatomical Feature Detection for Completeness of Abdominal FAST Exam

Author

Lee, HyeonWoo, primary, Zahiri, Mohsen, additional, Ghoshal, Goutam, additional, Schmidt, Stephen, additional, Schnittke, Nikolai, additional, Hicks, Bryson, additional, Kaili, Matt, additional, Gregory, Cynthia, additional, Feuerherdt, Magdelyn, additional, Thomas, Caelan, additional, Zhang, Yuan, additional, Hibbs, Katlyn, additional, Sreenivasan, Aishwarya, additional, Shupp, Jeffrey W., additional, Rizzo, Julie, additional, Gregory, Kenton, additional, and Raju, Balasundar, additional

Published
2023
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44. Standards in Biologic Lesions: Cutaneous Thermal Injury and Inhalation Injury Working Group 2018 Meeting Proceedings

Author

Moffatt, Lauren T, Madrzykowski, Daniel, Gibson, Angela L F, Powell, Heather M, Cancio, Leopoldo C, Wade, Charles E, Choudhry, Mashkoor A, Kovacs, Elizabeth J, Finnerty, Celeste C, Majetschak, Matthias, Shupp, Jeffrey W, Amini-Nik, Saeid, Cancio, Leopoldo C, Choudhry, Mashkoor A, Choudhry, Mashkoor A, Christy, Robert J, Finnerty, Celeste C, Gibson, Angela L F, Gurtner, Geoffrey C, Holmes, James H, IV, Kovacs, Elizabeth J, Majetschak, Matthias, Martyn, J A Jeevendra, Moffatt, Lauren T, Muthumalaiappan, Kuzhali, Powell, Heather M, Shupp, Jeffrey W, Supp, Dorothy M, Wade, Charles E, Grove, Brian, Tucholski, David, and Madrzykowski, Daniel

Published
2020
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