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

Autor:	Keyloun JW; The Burn Center, Department of Surgery, MedStar Washington Hospital Center, Washington, DC 20010, USA.; Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, DC 20010, USA., Le TD; Research Directorate, U.S. Army Institute of Surgical Research, JBSA Fort Sam Houston, TX 78234, USA.; Department of Epidemiology and Biostatistics, University of Texas Tyler School of Medicine, Tyler, TX 75708, USA., Moffatt LT; Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, DC 20010, USA.; Department of Biochemistry, Georgetown University, Washington, DC 20057, USA., Orfeo T; Department of Biochemistry, College of Medicine, University of Vermont, Colchester, VT 05405, USA., McLawhorn MM; Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, DC 20010, USA., Bravo MC; Department of Biochemistry, College of Medicine, University of Vermont, Colchester, VT 05405, USA., Tejiram S; The Burn Center, Department of Surgery, MedStar Washington Hospital Center, Washington, DC 20010, USA., Shupp JW; The Burn Center, Department of Surgery, MedStar Washington Hospital Center, Washington, DC 20010, USA.; Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, DC 20010, USA.; Department of Surgery, Georgetown University, Washington, DC 20057, USA., Pusateri AE; Combat Casualty Care and Operational Medicine Directorate, Naval Medical Research Unit San Antonio, JBSA Fort Sam Houston, TX 78234, USA.; Department of Surgery, Uniformed Services University of Health Sciences, Bethesda, MD 20814, USA.
Jazyk:	angličtina
Zdroj:	Journal of burn care & research : official publication of the American Burn Association [J Burn Care Res] 2024 Jan 05; Vol. 45 (1), pp. 70-79.
DOI:	10.1093/jbcr/irad152
Abstrakt:	Although use of thromboelastography (TEG) to diagnose coagulopathy and guide clinical decision-making is increasing, relative performance of different TEG methods has not been well-defined. Rapid-TEG (rTEG), kaolin-TEG (kTEG), and native-TEG (nTEG) were performed on blood samples from burn patients presenting to a regional center from admission to 21 days. Patients were categorized by burn severity, mortality, and fibrinolytic phenotypes (Shutdown [SD], Physiologic [PHYS], and Hyperfibrinolytic [HF]). Manufacturer ranges and published TEG cutoffs were examined. Concordance correlations (Rc) of TEG parameters (R, α-angle, maximum amplitude [MA], LY30) measured agreement and Cohen's Kappa (κ) determined interclass reliability. Patients (n = 121) were mostly male (n = 84; 69.4%), with median age 40 years, median TBSA burn 13%, and mortality 17% (n = 21). Severe burns (≥40% TBSA) were associated with lower admission α-angle for rTEG (P = .03) and lower MA for rTEG (P = .02) and kTEG (P = .01). MA was lower in patients who died (nTEG, P = .04; kTEG, P = .02; rTEG, P = .003). Admission HF was associated with increased mortality (OR, 10.45; 95% CI, 2.54-43.31, P = .001) on rTEG only. Delayed SD was associated with mortality using rTEG and nTEG (OR 9.46; 95% CI, 1.96-45.73; P = .005 and OR, 6.91; 95% CI, 1.35-35.48; P = .02). Admission TEGs showed poor agreement on R-time (Rc, 0.00-0.56) and α-angle (0.40 to 0.55), and moderate agreement on MA (0.67-0.81) and LY30 (0.72-0.93). Interclass reliability was lowest for R-time (κ, -0.07 to 0.01) and α-angle (-0.06 to 0.17) and highest for MA (0.22-0.51) and LY30 (0.29-0.49). Choice of TEG method may impact clinical decision-making. rTEG appeared most sensitive in parameter-specific associations with injury severity, abnormal fibrinolysis, and mortality. (© The Author(s) 2023. Published by Oxford University Press on behalf of the American Burn Association.)
Databáze:	MEDLINE
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