Association of the Circulating Supar Levels with Inflammation, Fibrinolysis, and Outcome in Severe Burn Patients.

BACKGROUND: Hyperfibrinolysis and pro/anti-inflammatory imbalance usually occur in the early stage of severe burns. Soluble urokinase-type plasminogen activator receptor (suPAR) is involved in fibrinolysis and inflammation. To date, the levels of circulating suPAR in non-survivors with severe burns remain unknown. This study aimed to investigate the early association between circulating suPAR levels and biomarkers of fibrinolysis, pro/anti-inflammatory, and prognosis. METHODS: Sixty-four consecutive Chinese patients with severe burns and 26 healthy volunteers were enrolled in a prospective observational cohort. Clinical characteristics and laboratory data were collected prospectively. Blood samples were collected at 48 h post-burn, and suPAR and biomarkers of pro/anti-inflammatory and fibrinolysis were detected by enzyme-linked immunosorbent assays. Important indicators between non-survivors and survivors were compared. Linear regression analysis was performed to screen variables associated with suPAR. Logistic regression analysis and receiver operating characteristic curve (ROC) analysis were performed to evaluate the prognostic value of suPAR. RESULT: Compared with the control group, the circulating suPAR levels in the survivors (P < 0.001) and non-survivors (P = 0.017) were higher. Compared with survivors, non-survivors had lower circulating suPAR levels at 48 h post-burn, and they showed a higher degree of fibrinolysis (higher D-dimer) and a lower TNF-α/IL-10 ratio. According to linear regression analysis, the variables independently associated with a lower suPAR level were lower platelet factor 4 (PF-4), urokinase-type plasminogen activator (uPA), and TNF-α/IL-10 levels and a higher D-dimer level. Logistic regression and ROC analyses indicated that a suPAR level ≤ 4.70 µg/L was independently associated with 30-day mortality. CONCLUSION: Low circulating suPAR levels at 48 h post-burn in severe burn patients may reflect decreased TNF-α/IL-10 ratio and increased hyperfibrinolysis. suPAR can predict 30-day mortality in patients with severe burn.

Low-soluble TREM-like transcript-1 levels early after severe burn reflect increased coagulation disorders and predict 30-day mortality.

BACKGROUND: Patients with severe burns often show systemic coagulation changes in the early stage and even develop extensive coagulopathy. Previous studies have confirmed that soluble TREM-like transcript-1 (sTLT-1) mediates a novel mechanism of haemostasis and thrombosis in inflammatory vascular injury. At present, the role of sTLT-1 in patients with severe burns is not well known. OBJECTIVE: To investigate the early association between sTLT-1 levels and markers of burn severity, coagulation disorders, endothelial permeability, shock and prognosis in patients with severe burns. METHODS: A prospective, observational study was conducted with 60 severe burn patients (divided into a death group and a survival group according to 30-day prognosis) admitted to our hospital. Twenty-eight healthy volunteers were recruited as the control group. Blood components at 48 h after burn were analysed for sTLT-1 and biomarkers reflecting platelet activation, shock, endothelial glycocalyx damage, capillary leakage, haemostasis, fibrinolytic activity, natural anticoagulation and blood cells. We compared the three groups, analysed the correlation between sTLT-1 and biomarkers, and investigated the predictive value of sTLT-1 for 30-day prognosis. RESULT: Compared with the surviving patients, the patients who died had a lower degree of platelet activation [lower sTLT-1, platelet factor 4 (PF-4) and platelet counts] and a higher degree of burn [higher abbreviated burn severity index score (ABSI score)], shock (higher lactate), endothelial glycocalyx damage [higher syndecan-1 and soluble thrombomodulin (sTM)] and capillary leakage [higher resuscitation fluid (0-48 h), lower albumin] as well as decreased haemostasis [higher activated partial prothrombin time (APTT), lower fibrinogen and thrombin-antithrombin III complex (TAT)], increased fibrinolytic activity [higher D-dimer and tissue-type plasminogen activator (tPA)] and decreased natural anticoagulation [lower protein C (PC) and protein S (PS)]. Higher D-dimer (P = 0.013) and lower PF-4 (P = 0.001) were significantly independently associated with lower sTLT-1. Low circulating sTLT-1 (a unit is 50 pg/mL) (odds ratio [OR] 2.08 [95% CI 1.11-3.92], P = 0.022) was an independent predictor of increased 30-day mortality. CONCLUSION: Low sTLT-1 levels at 48 h after burn in patients with severe burns is associated with increased coagulation disorders. Low circulating sTLT-1 levels were an independent predictor of increased 30-day mortality.

[Comparison of the incidence of postoperative complications following laparoscopic and open colorectal cancer resection].

OBJECTIVE: To compare the postoperative complications following laparoscopic and open colorectal cancer resection. METHODS: From January 2000 to September 2011, 910 patients underwent laparoscopic surgery and 434 open surgery. The postoperative complications were compared between the two groups. RESULTS: Forty-eight patients (5.3%, 48/910) in the laparoscopic group were converted to open operation, of whom 36 (75.0%, 36/48) were due to difficulty in procedure and exposure from obesity and narrow pelvis. The overall complication rate was 20.3% (185/910) in the laparoscopic group and 25.3%(110/434) in the open group (χ2=4.316, P<0.05). For patients with a diverting stoma, the anastomotic leak rate was 2.1% (3/145) and 2.2% (2/93) (χ2=0.002, P>0.05), anastomotic bleeding rate was 3.4% (5/145) and 4.3% (4/93) (χ2=0.113, P>0.05). For patients without a diverting stoma, the anastomotic leak rate was 3.1% (22/699) and 1.0% (3/301) (χ2=3.993, P<0.05), anastomotic bleeding rate was 1.6% (11/699) and 2.3% (7/301) (χ2=0.673, P>0.05), bowel obstruction rate was 3.4% (31/910) and 5.8% (25/434) (χ2=4.077, P<0.05), chyle leak rate was 5.8% (53/910) and 3.7% (16/434) (χ2=2.757, P>0.05), urinary retention rate was 1.5% (14/910) and 1.6% (7/434) (χ2=0.011, P>0.05), wound infection rate was 2.2% (20/910) and 4.6% (20/434) (χ2=5.913, P<0.05), pulmonary infection rate was 6.4% (58/910) and 10.6% (46/434) (χ2=7.349, P<0.05). CONCLUSION: The overall postoperative complication rate in laparoscopic surgery is significantly lower than that in open surgery.