Effect of artificial colloids on blood coagulation during shock stage of severe burn injury
Authors: ZHOU Jian-jun , XING Nan , CHEN Jiong , SHI Jian-wu , SU Guo-liang 
Published: January 2024

Background
There are controversies about the use of artificial colloids. This research was aimed to determine the effect of various artificial colloids on blood coagulation in the shock stage of severe burn injury.

Methods
Totally, 18 female Ba-Ma mini-pigs were subjected to a 40% total body surface third-degree flame burn under anesthesia. Resuscitation therapy was applied 2 hours after the injury, using the burn shock fluid resuscitation formula commonly accepted in the surgical treatment of burns. The Ba-Ma mini-pigs were randomly assigned to three groups (six pigs in each group): succinylated gelatin group (the artificial colloid used was succinylated gelatin Injection), hydroxyethyl starch group (the artificial colloid used was hydroxyethyl starch (130/0.4)), and allogeneic plasma group (the colloid used was allogeneic plasma). Blood samples were collected from the animals prior to the burn injury and again at intervals of 4, 8, 24 and 48 hours post-injury. The platelet count (PLT), prothrombin time (PT), international normalized ratio (INR), activated partial thromboplastin time (APTT), and fibrinogen (Fib) were measured, followed by a statistical analysis of all results.

Results
The PLT of succinylated gelatin group and hydroxyethyl starch group at intervals of 24 and 48 hours were (124.3±52.7), (78.8±16.4)×109/L and (159.0±62.8), (87.3±32.0) × 109/L respectively. But in the allogeneic plasma group at intervals of 8, 24, and 48 hours were (234.3±52.6), (136.0±47.4), (75.8±31.0) × 109/L. The decrease were all statistically significant (P <0.05, P <0.01) when compared to pre-burn ((383.3±77.9), (382.7±65.7), (381.0±49.4) × 109/L). The PLT among the three groups, at all the time points, had no statistical difference (P >0.05). Compared to pre-burn ((10.8±0.9), (11.4± 0.8), (10.6±0.7) seconds), the PT of succinylated gelatin group and hydroxyethyl starch group at 24 hours were (14.5±1.5) and (16.2±1.3) seconds, whereas in the allogeneic plasma group at 8 and 24 hours the PT were (13.0±0.9) and (14.5±1.5) seconds, i.e., an increase in the statistical significance (P >0.01). Statistical significance was observed at 8 and 48 hours between the succinylated gelatin group and hydroxyethyl starch group, and at 48 hours between the hydroxyethyl starch and allogeneic plasma group (P <0.05). The INR at 24 hours were (1.26±0.13) in the succinylated gelatin group, (1.40±0.11) in the hydroxyethyl starch group, and (1.13± 0.07) and (1.26±0.13) at 8 and 24 hours in the allogeneic plasma group. When compared with pre-burn ((0.94±0.08), (0.99± 0.07), and (0.92±0.06) seconds), the other groups have increased significantly (P>0.01). The comparison at 8 and 48 hours between the succinylated gelatin group and the hydroxyethyl starch group, at 48 hours between hydroxyethyl starch group and allogeneic plasma group showed statistical difference (P <0.01). The APTT of succinylated gelatin group and hydroxyethyl starch group at 24 hours were (13.1±1.1) and (14.6±2.9) seconds. The APTT of the allogeneic plasma group at 4, 8 and 24 hours were (10.9±1.4), (11.8±1.1), and (13.7±1.5) seconds. Compared to pre-burn ((11.5±4.2), (11.2±3.3), (10.1±1.4) seconds), they were statistically significant (P <0.05). There was no statistical difference in the APTT between the three groups, at all the time points. The Fib of the succinylated gelatin group at 24 and 48 hours were (4.3±0.3) and (4.7±0.2) g/L, (4.1±0.3), and (5.0±0.1) g/L in allogeneic plasma group, and at 8, 24, and 48 hours the Fib for the hydroxyethyl starch group was (2.9±0.4), (4.0±0.5), and (4.6±0.6) g/L. Compared to pre-burn ((2.4±0.2), (2.5±0.3), (2.6±0.5) g/L), they were all statistically significant (P <0.01). There was no statistical difference in APTT between the three groups, at all time points.

Conclusion
The changes of the indices in blood coagulation during the shock phase of a severe burn injury correlate with the stress response to the burn, rather than to the application of HES (130/0.4) and succinylated gelatin.