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Trauma and Thermal Injury: Comparison of Hemostatic and Cytokine Changes in the Acute Phase of Injury

Kowal-Vern, Areta MD; Sharp-Pucci, Mary Margaret EdD, MPH; Walenga, Jeanine M. PhD; Dries, David J. MSE, MD; Gamelli, Richard L. MD

Journal of Trauma and Acute Care Surgery: February 1998 - Volume 44 - Issue 2 - p 325-329

Background Initiated either by thermal injury or mechanical trauma, the systemic inflammatory response syndrome stimulates activation of coagulation and fibrinolysis, evolving into a subclinical disseminated intravascular coagulation.

Method Hemostatic parameters, interleukin-6, and endothelin plasma levels were compared in burn and trauma patients. Nineteen patients with major burn injury (>or=to40% total body surface area) were compared with 35 trauma patients with Injury Severity Scores > 25 on day 1 and days 5 to 8.

Results Thrombin-antithrombin levels were significantly higher in trauma patients than in burn patients (p < 0.0001) on day 1, and endothelin was significantly higher on days 1 and 5 (p < 0.0001) in trauma patients than in burn patients. Interleukin-6 plasminogen activator inhibitor-1, and tissue plasminogen activator levels were elevated above normal limits on both days in both groups.

Conclusion There was a difference in the degree and level to which homeostasis was perturbed between the two groups. The mechanism of injury did not affect the initiation of subclinical disseminated intravascular coagulation and cytokine release, and the physiologic response remained the same.

From the Department of Pathology, Hemostasis and Thrombosis Research Laboratory (A.K.-V., J.M.W.), and the Department of Surgery, Burn Shock Trauma Institute (A.K.-V., M.M.S.-P., D.J.D., R.L.G.), Loyola University Medical Center, Maywood, Illinois.

Address for reprints: Areta Kowal-Vern, MD, Department of Pathology, Loyola University Medical Center, 2160 South First Avenue, Maywood, IL 60153.

© Williams & Wilkins 1998. All Rights Reserved.