Skin graft surgery and its impact on platelet counts in Iranian burn patients: a non-randomized clinical trial.

BACKGROUND: Platelets are critical in maintaining homeostasis and immune response in burn patients. The concentration of platelets decreases in burn patients, and any intervention that increases serum platelet concentration can prevent serious consequences and patient death. The present study aimed to assess the impact of skin graft surgery on burn patients' platelet counts. METHODS: In this non-randomized clinical trial, 200 burn patients were investigated. The patients were recruited from the surgical ward of Imam Khomeini Teaching Hospital during the first six months of 2021. After completing the checklist, patients underwent skin graft surgery. Blood was taken from the patients during surgery in the operating room and on the third and fifth day after the surgery to check platelets. Data analysis was conducted using SPSS software (ver. 22.0). RESULTS: Most patients (63.5%) were male, and 73 (36.5%) were female. One hundred eighty-one patients (90.5%) had deep burns, and 19 (9.5%) had superficial burns. The mean burns percentage in the patients was 19.3 ± 15.4%, the lowest was 2%, and the highest was 90%. The most common burns were caused by flame (42%) and boiling water (30.5%). The patients' outcomes revealed that 6% gained complete recovery, 86.5% partial recovery, 2.5% showed transplant rejection, and 5% died. Mean platelet levels in deceased patients had an upward trend. The mean platelet counts of patients were elevated during surgery (289,855 ± 165,378), decreased three days after surgery (282,778 ± 317,310), and elevated again five days after surgery (330,375 ± 208,571). However, no significant difference was found between the mean platelet counts during surgery, the third and fifth days after surgery in patients undergoing skin grafts (P = 0.057). CONCLUSIONS: This study suggests that skin graft positively increases the patient's platelets. Further studies are needed to confirm the findings and elucidate the mechanism. Iranian Registry of Clinical Trial approval code (IRCT# IRCT20131112015390N8 & 06/01/2024).

Neutrophil-to-lymphocyte ratio in patients with gram-negative sepsis admitted to intensive care unit.

INTRODUCTION: Several studies have investigated the role of Neutrophil to Lymphocyte Ratio (N/L ratio) in the early diagnosis of infection, which had different results. We assessed this ratio in early diagnosis of Gram-negative sepsis admitted to ICU. METHODS: This cross sectional study was approved by ethics committee of Urmia University of Medical Sciences and conducted during 2015. All patients with gram negative sepsis admitted to general intensive care unit (GICU) were enrolled. Demographic characteristics, APACHE II score, duration of mechanical ventilation and ICU length of stay, average neutrophil, lymphocyte count, and their ratio on the first, second and third day of hospitalization, and mortality were recorded. P < 0.05 was significant. RESULTS: One hundred and thirty nine patients were studied during one year with mean age 68.29 ±17. 4 years. 136 patients received mechanical ventilation with mean 13.85 ±2.07 days. The mean white blood cells count on the first day of hospitalization was 11776.04±5789.60,and on the second and third days was 12446±2101.16 and 13241.01 ± 7077.17, respectively. The ratio of neutrophil to lymphocyte on the day of hospitalization was 11.38±1.02. This ratio on the second and third days was 11.98±0.99 and 12.94±1.3, respectively. Furthermore, 46.8% of patients died. According to the T-test, significant difference was seen between two groups in term of APACHEII score, count of neutrophil, WBC and N/L ratio on the second and third days (p < 0.05). CONCLUSION: Blood cell analysis and N/L ratio can be used as a predictor for severity of gram negative sepsis along with other diagnostic procedures.