TRAUMA AND THERMAL-INJURY - COMPARISON OF HEMOSTATIC AND CYTOKINE CHANGES IN THE ACUTE-PHASE OF INJURY

Background: Initiated either by thermal injury or mechanical trauma, t he systemic inflammatory response syndrome stimulates activation of co agulation and fibrinolysis, evolving into a subclinical disseminated i ntravascular coagulation. Method: Hemostatic parameters, interleukin-6 , and endothelin plasma levels were compared in burn and trauma patien ts. Nineteen patients with major burn injury (greater than or equal to 40% total body surface area) were compared with 35 trauma patients wi th Injury Severity Scores > 25 on day 1 and days 5 to 8. Results: Thro mbin-antithrombin levels were significantly higher in trauma patients than in burn patients (p < 0.0001) on day 1, and endothelin was signif icantly higher on days 1 and 5 (p < 0.0001) in trauma patients than in burn patients. Interleukin-6 plasminogen activator inhibitor-1, and t issue plasminogen activator levels were elevated above normal limits o n both days in both groups.Conclusion: There was a difference in the d egree and level to which homeostasis was perturbed between the two gro ups. The mechanism of injury did not affect the initiation of subclini cal disseminated intravascular coagulation and cytokine release, and t he physiologic response remained the same.