Features of the hemostatic system at combat-caused acoustic injuries
Authors: Shidlovskaya Tetiana A. , Burlaka Julia B. , Voroshilova Natalya M. , Petruk Lyubov G. , Verevka Sergiy V. 
Published: August 2022

Introduction: Exposure to high-intensity sounds can cause significant damage to the human auditory system. Joint damage to the auditory system by high-intensity sound and shock waves causes acubarotrauma. Such lesions are systemic in nature, affecting not only the auditory system but also the entire human body. It significantly impairs the quality of life and general condition of the body, causes numerous complications. Therefore, the issues of diagnosis and treatment of hearing impairments caused by acutraumas and acubarotraumas received in combat conditions are highly relevant.
Aim: to study the hemostatic indices of patients with combat-caused acoustic trauma and identify the most informative ones.
Patients and methods: 22 patients with combat acoustic trauma and 10 healthy volunteers were tested. The object of the study was citrate plasma, which was obtained by standard methods. The content of fibrinogen was determined by thrombin-like enzyme Ancistron-H. Partially activated thromboplastin time and prothrombin time were determined by tests of Siemens, USA. The share of functionally inactive forms of prothrombin was determined by Ecamulin-based diagnostic test. The content of protein C activity was determined by cleavage of synthetic chromogenic substrate (Siemens, USA). The concentrations of soluble fibrin and D-dimer were evaluated by immunodiagnostic test systems "DIA-soluble fibrin" and "DIA-D-dimer" (Diaprof-Med, Ukraine). Statistical processing of the results was performed by WinPEPI package for biometric statistical processing with Student's t-test for evaluation of the difference between patients and the control group.
Results and discussion: It was found that fibrinogen’s level in 25% of patients remained at the level of control. In 27% of patients this index decreased on the level of the trend, and in 50% - increased 1.6 times. The elevat ion of fibrinogen’s level proves for a risk of thrombotic complications, since this acute phaseprotein is well-known index of hypercoagulability. Partially activated thromboplastin time index in 14% of the tested group remained at the level of control values. In 14% of patients it was probably 1.4 times shorter, and in 73% of patients it was 1.6 times longer than control. Prolonged partially activated thrombin time may prove for the increased level of circulating coagulation factor VIII. In 82% of patients the index of prothrombin time was probably 2.4 times prolonged, where as in 18% of patients was almost at the level of control. It may prove for an imbalance between the components of blood clotting system. The indices of Ecamulin-based test were multidirectional. In 18% of patients it was on the level of control, in 55% of patients it was slightly shorter, and in 27% of patients - probably elongated 1.4 times. The level functionally inactive forms of prothrombin in 50% of patients didn’t differ of control values, in 23% it was tended to decrease, and in 27% it was 1.6 more. The latter proves for the activation of the blood coagulation system. Protein C is a physiological inhibitor of the blood coagulation system. Its’ level in 50% of patients was reduced by 2.2 times in contrast to control, in 14% it remained on the normal level. As well-known, a decrease in protein C level proves for imbalance between coagulation and anticoagulation in the direction of the first one and is associated with thrombosis.
The content of D-dimer in 33% of patients was on the level of control, while the level of soluble fibrin was increased 4 times. In 42% there was a 1.4-fold decrease in D-dimer content at a slight increase of soluble fibrin level. In 25% of patients the indices of D-dimer and soluble fibrin were increased in 4 and 7 times, respectively. Elevated level of soluble fibrin is an early prognostic index of the activation of blood clotting system. Comprehensive determination of the content of soluble fibrin and the level of D-dimer allows to estimate the correlation between the accumulation and destruction of the soluble fibrin.
Conclusion: From the above data it follows that the determination of the single index is not enough for adequate assess of the risk of thrombosis and the effectiveness of antithrombotic therapy. On this reason the comprehensive definition of the noted indices should be included into the clinical practice a mandatory algorithm for the diagnosis of prothrombotic conditions in patients with acoustic trauma hearing disturbances.