[Dynamic pathological mechanisms and clinical translation of thermal burns and acid corrosive injury: a multidimensional analysis based on inflammatory phases, organ damage, and coagulation disorders].

OBJECTIVE

To compare extremely severe thermal burns with acid corrosive injury in terms of multidimensional clinical differences, and elucidate their distinct pathophysiological characteristics.

METHODS

A retrospective cohort study was conducted to collect the clinical data of 23 patients with extremely severe thermal burns and 14 patients with acid corrosive injury admitted to Suzhou Municipal Hospital from January 2020 to December 2024. The patients were divided into thermal burn group and acid corrosive injury group based on the causative factors. The basic data (gender, age, and whether they had underlying diseases), and blood cell analysis indicators [white blood cell count (WBC), neutrophil count (NEUT), platelet count (PLT), platelet/lymphocyte ratio (PLR)], organ function indicators [albumin (Alb), alanine aminotransferase (ALT), aspartate aminotransferase (AST), serum creatinine (SCr), blood urea nitrogen (BUN)], coagulation function indicators [D-dimer, fibrinogen (Fib), activated partial thromboplastin time (APTT)], and infection indicators [procalcitonin (PCT), C-reactive protein (CRP), heparin-binding protein (HBP), interleukin-6 (IL-6)] on the 1st, 2nd, 3rd, 7th, and 15th day after injury, as well as the severity of injury and wound healing time were compared between the two groups.

RESULTS

There were no statistically significant differences in the basic data of patients between the thermal burn group and the acid corrosive injury group. The levels of WBC, NEUT, PLT and PLR in the thermal burn group were higher than those in the acid corrosive injury group, and there was a group effect (F values were 56.198, 50.133, 25.325 and 19.503, respectively, all P<0.05). The Alb level of patients in the acid corrosive injury group was higher on the first day, and there was an interaction effect between group and time point (F=7.893, P<0.05), but it decreased on the 7th and the 15th day after injury. The SCr level of patients in the thermal burn group increased, and there was a group effect (F=93.991, P<0.05). On the 15th day, the BUN level of patients in the acid corrosive injury group was higher, and there was an interaction effect between group and time point (F=5.033, P<0.05). In the early stage of burn (from the 2nd day to the 7th day), the D-dimer level of patients in the thermal burn group was higher, on the 15th day, the D-dimer, Fib and APTT levels of patients in the acid corrosive injury group were higher, and there was an interaction effect between group and time point (F values were 13.891, 10.170 and 8.530, respectively, all P<0.05). Compared with the acid corrosive injury group, the patients in the thermal burn group had elevated HBP, CRP, PCT, and IL-6 as early as the 2nd day and the 3rd day after injury, showing a group effect (F values were 139.123, 146.879, 31.831, and 24.506, respectively, all P<0.05). Although the absolute values of above infection indicators in the acid corrosive injury group were lower, they persisted for a longer time, indicating a time point effect (F values were 186.566, 55.375, 24.607, and 29.986, respectively, all P<0.05). The total burn area of patients in the thermal burn group was larger than that of the acid corrosive injury group [(74.4±10.7)% total body surface area (TBSA) vs. (62.3±9.8)% TBSA, P<0.05], while the wound healing time of patients in the acid corrosive injury group was longer than that in the thermal burn group (days: 57.6±10.3 vs. 48.4±8.1, P<0.05).

CONCLUSIONS

Thermal burns are fundamentally characterized as "persistent high-inflammation-driven injuries," whereas acid corrosive injuries are primarily defined by "progressive metabolic and coagulation dysfunction injuries". The two types of injuries exhibit significant differences in the intensity of the inflammatory response, the pattern of organ damage, and the timing of coagulation dysfunction onset.