Fibrinolytic Activation and Its Association with Mortality After Traumatic and Thermal Injury

Objective: Characterize plasma markers of fibrinolytic activation and their associations with mortality in burn and trauma patients from hospital admission through 48 hours. Summary Background Information: Fibrinolytic activation following burn and non-burn trauma is associated with increased mortality. Whether fibrinolytic activation differs between burn and non-burn injury is unknown. Methods: Adult patients aged 18 years and older who presented to one of two regional trauma centers or one regional burn center within 4 hours of injury were included. Blood was collected at admission and at hours 2, 4, 6, 8, 12, 24, 36, and 48. Plasmin-antiplasmin complex (PAP), D-dimer, and plasminogen concentrations in plasma were determined. Results: Of 590 patients, 58.3% presented with blunt, 27.1% with thermal, and 14.6% with penetrating injury. Admission PAP and D-dimer were higher in trauma (blunt and penetrating groups combined) than in burn patients (p<.001). Non-survivors (injury types combined) had higher PAP and D-dimer and lower plasminogen (p<.001) at admission and over time. After adjusting for age, injury severity and % total body surface area burned, admission PAP ≥1645.6 ng/mL was associated with 7.0 times higher odds for mortality (p=.002) and D-dimer ≥6.5 µg/mL was associated with 5.0 times higher odds for mortality (p=.01). Changes in biomarkers over time were similar between trauma and burn patients. Conclusions: Higher fibrinolytic activation was associated with mortality in trauma and burn patients. Trauma patients had higher fibrinolytic activation markers than burn patients, while patterns of change were similar. Data suggest potential for use of similar resuscitative adjuncts to mitigate early fibrinolytic dysfunction in trauma and burns.