The Utilisation of INR to identify coagulopathy in burn patients

Kendall Wermine; Juquan Song; Sunny Gotewal; Lyndon Huang; Kassandra Corona; Shelby Bagby; Elvia Villarreal; Shivan Chokshi; Tsola Efejuku; Jasmine Chaij; Alejandro Joglar; Nicholas J. Iglesias; Phillip Keys; Giovanna De La Tejera; Georgiy Golovko; Amina El Ayadi; Steven E. Wolf

doi:10.1371/journal.pone.0278658

The Utilisation of INR to identify coagulopathy in burn patients

Kendall Wermine, Juquan Song, Sunny Gotewal, Lyndon Huang, Kassandra Corona, Shelby Bagby, Elvia Villarreal, Shivan Chokshi, Tsola Efejuku, Jasmine Chaij, Alejandro Joglar, Nicholas J. Iglesias, Phillip Keys, Giovanna De La Tejera, Georgiy Golovko, Amina El Ayadi, Steven E. Wolf

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Abstract

Studies conflict on the significance of burn-induced coagulopathy. We posit that burn-induced coagulopathy is associated with injury severity in burns. Our purpose was to characterize coagulopathy profiles in burns and determine relationships between % total burn surface area (TBSA) burned and coagulopathy using the International Normalized Ratio (INR). Burned patients with INR values were identified in the TriNetX database and analyzed by %TBSA burned. Patients with history of transfusions, chronic hepatic failure, and those on anticoagulant medications were excluded. Interquartile ranges for INR in the burned study population were 1.2 (1.0–1.4). An INR of ≥ 1.5 was used to represent those with burn-induced coagulopathy as it fell outside the 3rd quartile. The population was stratified into subgroups using INR levels <1.5 or ≥1.5 on the day of injury. Data are average ± SD analyzed using chi-square; p < .05 was considered significant. There were 7,364 burned patients identified with INR <1.5, and 635 had INR ≥1.5. Comparing TBSA burned groups, burn-induced coagulopathy significantly increased in those with ≥20% TBSA; p = .048 at 20–29% TBSA, p = .0005 at 30–39% TBSA, and p < .0001 for 40% TBSA and above. Age played a significant factor with average age for those with burn-induced coagulopathy 59 ± 21.5 years and 46 ± 21.8 for those without (p < .0001). After matching for age, TBSA, and demographics, the risk of 28 day-mortality was higher in those with burn-induced coagulopathy compared to those without (risk difference 20.9%, p < .0001) and the odd ratio with 95% CI is 4.45 (3.399–5.825). Investigation of conditions associated with burn-induced coagulopathy showed the effect of heart diseases to be significant; 53% of patients with burn-induced coagulopathy had hypertension (p < .0001). Burn-induced coagulopathy increases with %TBSA burned. The information gained firmly reflects a link between %TBSA and burn-induced coagulopathy, which could be useful in prognosis and treatment decisions.

Original language	English (US)
Article number	e0278658
Journal	PloS one
Volume	19
Issue number	2 February
DOIs	https://doi.org/10.1371/journal.pone.0278658
State	Published - Feb 2024

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10.1371/journal.pone.0278658

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Wermine, K., Song, J., Gotewal, S., Huang, L., Corona, K., Bagby, S., Villarreal, E., Chokshi, S., Efejuku, T., Chaij, J., Joglar, A., Iglesias, N. J., Keys, P., Tejera, G. D. L., Golovko, G., Ayadi, A. E., & Wolf, S. E. (2024). The Utilisation of INR to identify coagulopathy in burn patients. PloS one, 19(2 February), Article e0278658. https://doi.org/10.1371/journal.pone.0278658

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title = "The Utilisation of INR to identify coagulopathy in burn patients",

abstract = "Studies conflict on the significance of burn-induced coagulopathy. We posit that burn-induced coagulopathy is associated with injury severity in burns. Our purpose was to characterize coagulopathy profiles in burns and determine relationships between % total burn surface area (TBSA) burned and coagulopathy using the International Normalized Ratio (INR). Burned patients with INR values were identified in the TriNetX database and analyzed by %TBSA burned. Patients with history of transfusions, chronic hepatic failure, and those on anticoagulant medications were excluded. Interquartile ranges for INR in the burned study population were 1.2 (1.0–1.4). An INR of ≥ 1.5 was used to represent those with burn-induced coagulopathy as it fell outside the 3rd quartile. The population was stratified into subgroups using INR levels <1.5 or ≥1.5 on the day of injury. Data are average ± SD analyzed using chi-square; p < .05 was considered significant. There were 7,364 burned patients identified with INR <1.5, and 635 had INR ≥1.5. Comparing TBSA burned groups, burn-induced coagulopathy significantly increased in those with ≥20% TBSA; p = .048 at 20–29% TBSA, p = .0005 at 30–39% TBSA, and p < .0001 for 40% TBSA and above. Age played a significant factor with average age for those with burn-induced coagulopathy 59 ± 21.5 years and 46 ± 21.8 for those without (p < .0001). After matching for age, TBSA, and demographics, the risk of 28 day-mortality was higher in those with burn-induced coagulopathy compared to those without (risk difference 20.9%, p < .0001) and the odd ratio with 95% CI is 4.45 (3.399–5.825). Investigation of conditions associated with burn-induced coagulopathy showed the effect of heart diseases to be significant; 53% of patients with burn-induced coagulopathy had hypertension (p < .0001). Burn-induced coagulopathy increases with %TBSA burned. The information gained firmly reflects a link between %TBSA and burn-induced coagulopathy, which could be useful in prognosis and treatment decisions.",

author = "Kendall Wermine and Juquan Song and Sunny Gotewal and Lyndon Huang and Kassandra Corona and Shelby Bagby and Elvia Villarreal and Shivan Chokshi and Tsola Efejuku and Jasmine Chaij and Alejandro Joglar and Iglesias, {Nicholas J.} and Phillip Keys and Tejera, {Giovanna De La} and Georgiy Golovko and Ayadi, {Amina El} and Wolf, {Steven E.}",

year = "2024",

month = feb,

doi = "10.1371/journal.pone.0278658",

language = "English (US)",

volume = "19",

journal = "PloS one",

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T1 - The Utilisation of INR to identify coagulopathy in burn patients

AU - Wermine, Kendall

AU - Song, Juquan

AU - Gotewal, Sunny

AU - Huang, Lyndon

AU - Corona, Kassandra

AU - Bagby, Shelby

AU - Villarreal, Elvia

AU - Chokshi, Shivan

AU - Efejuku, Tsola

AU - Chaij, Jasmine

AU - Joglar, Alejandro

AU - Iglesias, Nicholas J.

AU - Keys, Phillip

AU - Tejera, Giovanna De La

AU - Golovko, Georgiy

AU - Ayadi, Amina El

AU - Wolf, Steven E.

PY - 2024/2

Y1 - 2024/2

N2 - Studies conflict on the significance of burn-induced coagulopathy. We posit that burn-induced coagulopathy is associated with injury severity in burns. Our purpose was to characterize coagulopathy profiles in burns and determine relationships between % total burn surface area (TBSA) burned and coagulopathy using the International Normalized Ratio (INR). Burned patients with INR values were identified in the TriNetX database and analyzed by %TBSA burned. Patients with history of transfusions, chronic hepatic failure, and those on anticoagulant medications were excluded. Interquartile ranges for INR in the burned study population were 1.2 (1.0–1.4). An INR of ≥ 1.5 was used to represent those with burn-induced coagulopathy as it fell outside the 3rd quartile. The population was stratified into subgroups using INR levels <1.5 or ≥1.5 on the day of injury. Data are average ± SD analyzed using chi-square; p < .05 was considered significant. There were 7,364 burned patients identified with INR <1.5, and 635 had INR ≥1.5. Comparing TBSA burned groups, burn-induced coagulopathy significantly increased in those with ≥20% TBSA; p = .048 at 20–29% TBSA, p = .0005 at 30–39% TBSA, and p < .0001 for 40% TBSA and above. Age played a significant factor with average age for those with burn-induced coagulopathy 59 ± 21.5 years and 46 ± 21.8 for those without (p < .0001). After matching for age, TBSA, and demographics, the risk of 28 day-mortality was higher in those with burn-induced coagulopathy compared to those without (risk difference 20.9%, p < .0001) and the odd ratio with 95% CI is 4.45 (3.399–5.825). Investigation of conditions associated with burn-induced coagulopathy showed the effect of heart diseases to be significant; 53% of patients with burn-induced coagulopathy had hypertension (p < .0001). Burn-induced coagulopathy increases with %TBSA burned. The information gained firmly reflects a link between %TBSA and burn-induced coagulopathy, which could be useful in prognosis and treatment decisions.

AB - Studies conflict on the significance of burn-induced coagulopathy. We posit that burn-induced coagulopathy is associated with injury severity in burns. Our purpose was to characterize coagulopathy profiles in burns and determine relationships between % total burn surface area (TBSA) burned and coagulopathy using the International Normalized Ratio (INR). Burned patients with INR values were identified in the TriNetX database and analyzed by %TBSA burned. Patients with history of transfusions, chronic hepatic failure, and those on anticoagulant medications were excluded. Interquartile ranges for INR in the burned study population were 1.2 (1.0–1.4). An INR of ≥ 1.5 was used to represent those with burn-induced coagulopathy as it fell outside the 3rd quartile. The population was stratified into subgroups using INR levels <1.5 or ≥1.5 on the day of injury. Data are average ± SD analyzed using chi-square; p < .05 was considered significant. There were 7,364 burned patients identified with INR <1.5, and 635 had INR ≥1.5. Comparing TBSA burned groups, burn-induced coagulopathy significantly increased in those with ≥20% TBSA; p = .048 at 20–29% TBSA, p = .0005 at 30–39% TBSA, and p < .0001 for 40% TBSA and above. Age played a significant factor with average age for those with burn-induced coagulopathy 59 ± 21.5 years and 46 ± 21.8 for those without (p < .0001). After matching for age, TBSA, and demographics, the risk of 28 day-mortality was higher in those with burn-induced coagulopathy compared to those without (risk difference 20.9%, p < .0001) and the odd ratio with 95% CI is 4.45 (3.399–5.825). Investigation of conditions associated with burn-induced coagulopathy showed the effect of heart diseases to be significant; 53% of patients with burn-induced coagulopathy had hypertension (p < .0001). Burn-induced coagulopathy increases with %TBSA burned. The information gained firmly reflects a link between %TBSA and burn-induced coagulopathy, which could be useful in prognosis and treatment decisions.

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The Utilisation of INR to identify coagulopathy in burn patients

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