Combining early coagulation and inflammatory status improves prediction of mortality in burned and nonburned trauma patients.

Myung (Michelle) S Park, Jose Salinas, Charles E. Wade, Jingjing Wang, Wenjun Martini, Anthony E. Pusateri, Gerald A. Merrill, Kevin Chung, Steven E. Wolf, John B. Holcomb

Research output: Contribution to journalArticle

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Abstract

BACKGROUND: After injury, there is a synergistic response between inflammation and coagulation systems. We hypothesized that combining markers of these processes and standard clinical indices would improve early prediction of in- hospital mortality in burned and nonburned trauma patients. METHODS: Patients admitted to the surgical or burn intensive care unit within 24 hours of injury with an anticipated stay >or=3 days were enrolled during a one year period. Upon admission, blood was drawn for thromboelastography, plasma-based clotting assays, and cytokine levels. Clinical indices and multiple organ dysfunction syndrome (MODS) scores were recorded. Candidate variables evaluated included age, percentage third degree burns, inhalation injury, percentage total body surface area burns, interleukin-6, tumor necrosis factor alpha, interleukin-8, prothrombin time, partial thromboplastin time (PTT), maximal amplitude reflective of clot strength, group (burn or nonburn) and admission MODS. Multiple logistic regression with stepwise selection and likelihood ratio test was performed to identify predictors for mortality. A receiver operating characteristic (ROC) curve was constructed to assess the diagnostic performance of identified predictors. Validation of the model with an additional cohort was performed. RESULTS: For model development, we enrolled 25 burned and 33 nonburned trauma patients (20 blunt and 13 penetrating injuries). Fifteen deaths occurred. Multiple logistic regression analysis identified six independent risk factors for death: age, percentage third degree burns, inhalation injury, tumor necrosis factor alpha level, maximal amplitude, and MODS score with an area under ROC curve of 0.961 (95% confidence interval: 0.891, 1.000, p < 0.05). The area under the ROC curve for the validation cohort (n = 66) was 0.936 (95% confidence interval: 0.875, 0.997, p < 0.001). CONCLUSION: Our model improves prediction of in-hospital mortality in comparison to previous methods for burn and nonburn trauma patients. Furthermore, our model is equally applicable to all patients regardless of type of traumatic injury (nonburn or burn). This improvement is because of the inclusion of patient's early coagulation and inflammatory status in addition to standard clinical indices. These data provide a baseline within which to measure incremental improvements in care.

Original languageEnglish (US)
JournalThe Journal of trauma
Volume64
Issue number2 Suppl
StatePublished - Feb 2008
Externally publishedYes

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Mortality
Wounds and Injuries
Multiple Organ Failure
Inhalation Burns
ROC Curve
Organ Dysfunction Scores
Hospital Mortality
Tumor Necrosis Factor-alpha
Logistic Models
Confidence Intervals
Thrombelastography
Partial Thromboplastin Time
Body Surface Area
Prothrombin Time
Interleukin-8
Burns
Intensive Care Units
Interleukin-6
Regression Analysis
Cytokines

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Park, M. M. S., Salinas, J., Wade, C. E., Wang, J., Martini, W., Pusateri, A. E., ... Holcomb, J. B. (2008). Combining early coagulation and inflammatory status improves prediction of mortality in burned and nonburned trauma patients. The Journal of trauma, 64(2 Suppl).

Combining early coagulation and inflammatory status improves prediction of mortality in burned and nonburned trauma patients. / Park, Myung (Michelle) S; Salinas, Jose; Wade, Charles E.; Wang, Jingjing; Martini, Wenjun; Pusateri, Anthony E.; Merrill, Gerald A.; Chung, Kevin; Wolf, Steven E.; Holcomb, John B.

In: The Journal of trauma, Vol. 64, No. 2 Suppl, 02.2008.

Research output: Contribution to journalArticle

Park, MMS, Salinas, J, Wade, CE, Wang, J, Martini, W, Pusateri, AE, Merrill, GA, Chung, K, Wolf, SE & Holcomb, JB 2008, 'Combining early coagulation and inflammatory status improves prediction of mortality in burned and nonburned trauma patients.', The Journal of trauma, vol. 64, no. 2 Suppl.
Park, Myung (Michelle) S ; Salinas, Jose ; Wade, Charles E. ; Wang, Jingjing ; Martini, Wenjun ; Pusateri, Anthony E. ; Merrill, Gerald A. ; Chung, Kevin ; Wolf, Steven E. ; Holcomb, John B. / Combining early coagulation and inflammatory status improves prediction of mortality in burned and nonburned trauma patients. In: The Journal of trauma. 2008 ; Vol. 64, No. 2 Suppl.
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abstract = "BACKGROUND: After injury, there is a synergistic response between inflammation and coagulation systems. We hypothesized that combining markers of these processes and standard clinical indices would improve early prediction of in- hospital mortality in burned and nonburned trauma patients. METHODS: Patients admitted to the surgical or burn intensive care unit within 24 hours of injury with an anticipated stay >or=3 days were enrolled during a one year period. Upon admission, blood was drawn for thromboelastography, plasma-based clotting assays, and cytokine levels. Clinical indices and multiple organ dysfunction syndrome (MODS) scores were recorded. Candidate variables evaluated included age, percentage third degree burns, inhalation injury, percentage total body surface area burns, interleukin-6, tumor necrosis factor alpha, interleukin-8, prothrombin time, partial thromboplastin time (PTT), maximal amplitude reflective of clot strength, group (burn or nonburn) and admission MODS. Multiple logistic regression with stepwise selection and likelihood ratio test was performed to identify predictors for mortality. A receiver operating characteristic (ROC) curve was constructed to assess the diagnostic performance of identified predictors. Validation of the model with an additional cohort was performed. RESULTS: For model development, we enrolled 25 burned and 33 nonburned trauma patients (20 blunt and 13 penetrating injuries). Fifteen deaths occurred. Multiple logistic regression analysis identified six independent risk factors for death: age, percentage third degree burns, inhalation injury, tumor necrosis factor alpha level, maximal amplitude, and MODS score with an area under ROC curve of 0.961 (95{\%} confidence interval: 0.891, 1.000, p < 0.05). The area under the ROC curve for the validation cohort (n = 66) was 0.936 (95{\%} confidence interval: 0.875, 0.997, p < 0.001). CONCLUSION: Our model improves prediction of in-hospital mortality in comparison to previous methods for burn and nonburn trauma patients. Furthermore, our model is equally applicable to all patients regardless of type of traumatic injury (nonburn or burn). This improvement is because of the inclusion of patient's early coagulation and inflammatory status in addition to standard clinical indices. These data provide a baseline within which to measure incremental improvements in care.",
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T1 - Combining early coagulation and inflammatory status improves prediction of mortality in burned and nonburned trauma patients.

AU - Park, Myung (Michelle) S

AU - Salinas, Jose

AU - Wade, Charles E.

AU - Wang, Jingjing

AU - Martini, Wenjun

AU - Pusateri, Anthony E.

AU - Merrill, Gerald A.

AU - Chung, Kevin

AU - Wolf, Steven E.

AU - Holcomb, John B.

PY - 2008/2

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N2 - BACKGROUND: After injury, there is a synergistic response between inflammation and coagulation systems. We hypothesized that combining markers of these processes and standard clinical indices would improve early prediction of in- hospital mortality in burned and nonburned trauma patients. METHODS: Patients admitted to the surgical or burn intensive care unit within 24 hours of injury with an anticipated stay >or=3 days were enrolled during a one year period. Upon admission, blood was drawn for thromboelastography, plasma-based clotting assays, and cytokine levels. Clinical indices and multiple organ dysfunction syndrome (MODS) scores were recorded. Candidate variables evaluated included age, percentage third degree burns, inhalation injury, percentage total body surface area burns, interleukin-6, tumor necrosis factor alpha, interleukin-8, prothrombin time, partial thromboplastin time (PTT), maximal amplitude reflective of clot strength, group (burn or nonburn) and admission MODS. Multiple logistic regression with stepwise selection and likelihood ratio test was performed to identify predictors for mortality. A receiver operating characteristic (ROC) curve was constructed to assess the diagnostic performance of identified predictors. Validation of the model with an additional cohort was performed. RESULTS: For model development, we enrolled 25 burned and 33 nonburned trauma patients (20 blunt and 13 penetrating injuries). Fifteen deaths occurred. Multiple logistic regression analysis identified six independent risk factors for death: age, percentage third degree burns, inhalation injury, tumor necrosis factor alpha level, maximal amplitude, and MODS score with an area under ROC curve of 0.961 (95% confidence interval: 0.891, 1.000, p < 0.05). The area under the ROC curve for the validation cohort (n = 66) was 0.936 (95% confidence interval: 0.875, 0.997, p < 0.001). CONCLUSION: Our model improves prediction of in-hospital mortality in comparison to previous methods for burn and nonburn trauma patients. Furthermore, our model is equally applicable to all patients regardless of type of traumatic injury (nonburn or burn). This improvement is because of the inclusion of patient's early coagulation and inflammatory status in addition to standard clinical indices. These data provide a baseline within which to measure incremental improvements in care.

AB - BACKGROUND: After injury, there is a synergistic response between inflammation and coagulation systems. We hypothesized that combining markers of these processes and standard clinical indices would improve early prediction of in- hospital mortality in burned and nonburned trauma patients. METHODS: Patients admitted to the surgical or burn intensive care unit within 24 hours of injury with an anticipated stay >or=3 days were enrolled during a one year period. Upon admission, blood was drawn for thromboelastography, plasma-based clotting assays, and cytokine levels. Clinical indices and multiple organ dysfunction syndrome (MODS) scores were recorded. Candidate variables evaluated included age, percentage third degree burns, inhalation injury, percentage total body surface area burns, interleukin-6, tumor necrosis factor alpha, interleukin-8, prothrombin time, partial thromboplastin time (PTT), maximal amplitude reflective of clot strength, group (burn or nonburn) and admission MODS. Multiple logistic regression with stepwise selection and likelihood ratio test was performed to identify predictors for mortality. A receiver operating characteristic (ROC) curve was constructed to assess the diagnostic performance of identified predictors. Validation of the model with an additional cohort was performed. RESULTS: For model development, we enrolled 25 burned and 33 nonburned trauma patients (20 blunt and 13 penetrating injuries). Fifteen deaths occurred. Multiple logistic regression analysis identified six independent risk factors for death: age, percentage third degree burns, inhalation injury, tumor necrosis factor alpha level, maximal amplitude, and MODS score with an area under ROC curve of 0.961 (95% confidence interval: 0.891, 1.000, p < 0.05). The area under the ROC curve for the validation cohort (n = 66) was 0.936 (95% confidence interval: 0.875, 0.997, p < 0.001). CONCLUSION: Our model improves prediction of in-hospital mortality in comparison to previous methods for burn and nonburn trauma patients. Furthermore, our model is equally applicable to all patients regardless of type of traumatic injury (nonburn or burn). This improvement is because of the inclusion of patient's early coagulation and inflammatory status in addition to standard clinical indices. These data provide a baseline within which to measure incremental improvements in care.

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