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

Abstract

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. 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. 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. 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.