Early coagulation disorder and the predictive value of D-dimer for deep vein thrombosis in major burn patients.

OBJECTIVE

To investigate coagulation disorders and thrombotic complications in the early stage after burn, and to evaluate the predictive reliability of D-dimer for deep vein thrombosis (DVT) diagnosis in major burn patients.

METHODS

This retrospective study was performed in the Department of Burns, Southwest Hospital, and included 288 adult major burn patients (≥40 % TBSA) without prophylactic anticoagulant therapy. All patients received routine screening assays of coagulation indicators and Doppler ultrasound scan (DUS) during the 28 days post-burn regardless of the clinical symptoms of DVT.

RESULTS

Coagulation abnormalities were commonly observed during the 28 days post-burn. There were 24 patients (8.33 %) diagnosed with DVT based on DUS on a median of 23 days after burn. Older age (OR=1.47) and increased insertions of central venous catheter (OR=1.67) were identified as independent risk factors for DVT. Serum D-dimer levels were elevated in 97.6 % (281/288) of patients in the first week post-burn. Patients identified with DVT had significantly higher serum D-dimer levels on the 3rd and 7th days post-burn. The D-dimer level on the 7th post-burn day showed a moderate predictive value for DVT by ROC analysis (AUC=0.711). The optimal threshold was 2.25 mg/L, with a sensitivity of 0.818 and a specificity of 0.566 at this threshold.

CONCLUSION

Early coagulation disorder can occur and last for over 28 days after major burn injury. The serum D-dimer level on the 7th post-burn day may be used as a risk factor to identify the individuals with high-risk of DVT among major burn patients.