{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T05:23:21Z","timestamp":1792819401658,"version":"4.5.0"},"reference-count":52,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2025,6,24]],"date-time":"2025-06-24T00:00:00Z","timestamp":1750723200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["EBJ"],"abstract":"<jats:p>Background: Coagulopathy in severe burn injury is associated with complications and mortality. Methods: We compared 3 tests (EXTEM, INTEM, FIBTEM) of rotational thromboelastometry (ROTEM), a viscoelastic coagulation assay (VCA), with conventional coagulation assays (CCAs), fibrinogen, d-dimers and coagulation factors during the five post-burn days in survivors and non-survivors with severe burn injury, in order to correlate the results with burn coagulopathy and prognosis. Results: Seventeen survivors and ten non-survivors, with mean total burn surface area of 33.78% were included. CCAs measurements were abnormal, but unable to detect coagulopathy. At day 2, D-dimers and fibrinogen levels were statistically augmented for non-survivors. Regarding VCAs, FIBTEM MCF increased for non-survivors at day 2 and remained increased for the whole post-burn period. Furthermore, FIBTEM A10 and A20 at day 2 and EXTEM A10, EXTEM A20, EXTEM MCF, and EXTEM CFT at day 5 took abnormal values for the same group (p &lt; 0.05). These changes were underlined through abnormal measurements of coagulation factors. Conclusions:CCAs are poor indicators of coagulation status in burn injury, whereas VCAs are more sensitive markers, demonstrating coagulopathy and patients at greater risk of mortality.<\/jats:p>","DOI":"10.3390\/ebj6030037","type":"journal-article","created":{"date-parts":[[2025,6,24]],"date-time":"2025-06-24T06:49:38Z","timestamp":1750747778000},"page":"37","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["It Is Written in the Clot: Coagulation Assessment in Severe Burn Injury"],"prefix":"10.3390","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2367-1248","authenticated-orcid":false,"given":"Eirini","family":"Nikolaidou","sequence":"first","affiliation":[{"name":"Department of Plastic, Reconstructive and Hand Surgery & Burns ICU, \u201cGeorge Papanikolaou\u201d General Hospital, 57010 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6261-3708","authenticated-orcid":false,"given":"Andriana","family":"Lazaridou","sequence":"additional","affiliation":[{"name":"Hematology Department-Hematopoietic Cell Transplantation Unit, Gene and Cell Therapy Center, \u201cGeorge Papanikolaou\u201d General Hospital, 57010 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina","family":"Iasonidou","sequence":"additional","affiliation":[{"name":"2nd Department of Intensive Care Medicine, \u201cGeorge Papanikolaou\u201d General Hospital, 57010 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra","family":"Tsaroucha","sequence":"additional","affiliation":[{"name":"Second Department of Surgery, Laboratory of Experimental Surgery, Democritus University of Thrace, 68100 Alexandroupolis, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9151-6413","authenticated-orcid":false,"given":"Sophia","family":"Papadopoulou","sequence":"additional","affiliation":[{"name":"Department of Plastic, Reconstructive and Hand Surgery & Burns ICU, \u201cGeorge Papanikolaou\u201d General Hospital, 57010 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6054-4961","authenticated-orcid":false,"given":"Eleni","family":"Kaldoudi","sequence":"additional","affiliation":[{"name":"Medical Physics and Medical Informatics, School of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2859-0845","authenticated-orcid":false,"given":"Apostolos","family":"Sovatzidis","sequence":"additional","affiliation":[{"name":"Department of Surgery, General Hospital of Giannitsa, 58100 Pella, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2107-6170","authenticated-orcid":false,"given":"Despoina","family":"Kakagia","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, Democritus University Hospital, 68100 Alexandroupolis, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,6,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"700","DOI":"10.1007\/s00134-007-0976-5","article-title":"Early coagulation disorders after severe burn injury: Impact on mortality","volume":"34","author":"Lavrentieva","year":"2008","journal-title":"Intensive Care Med."},{"key":"ref_2","first-page":"103","article-title":"Coagulation Disorders and Mortality in Burn Injury: A Systematic Review","volume":"35","author":"Nikolaidou","year":"2022","journal-title":"Ann. Burns Fire Disasters"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"429","DOI":"10.1055\/s-0030-1254051","article-title":"Disseminated intravascular coagulation in burn injury","volume":"36","author":"Lippi","year":"2010","journal-title":"Semin. Thromb. Hemost."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1016\/S0049-3848(97)00291-0","article-title":"Degree of hypercoagulability and hyperfibrinolysis is related to organ failure and prognosis after burn trauma","volume":"89","author":"Lorente","year":"1998","journal-title":"Thromb. Res."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"678","DOI":"10.1016\/j.burns.2022.05.003","article-title":"Coagulation dysfunction of severe burn patients: A potential cause of death","volume":"49","author":"Zhang","year":"2022","journal-title":"Burns"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"805","DOI":"10.1016\/j.burns.2020.10.011","article-title":"Effect of acute coagulopathy before fluid administration in mortality for burned patients","volume":"47","author":"Kaita","year":"2020","journal-title":"Burns"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1032","DOI":"10.1016\/j.jcrc.2015.06.014","article-title":"Comparison of point-of-care hemostatic assays, routine coagulation tests, and outcome scores in critically ill patients","volume":"30","author":"Larsson","year":"2015","journal-title":"J. Crit. Care"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"748","DOI":"10.1097\/TA.0b013e3181877a9c","article-title":"The coagulopathy of trauma: A review of mechanisms","volume":"65","author":"Hess","year":"2008","journal-title":"J. Trauma Acute Care Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"S427","DOI":"10.1097\/TA.0b013e318232e5ab","article-title":"Clotting factor deficiency in early trauma-associated coagulopathy","volume":"71","author":"Rizoli","year":"2011","journal-title":"J. Trauma Acute Care Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"433","DOI":"10.1055\/s-0037-1599155","article-title":"Point-of-care testing in burn patients","volume":"43","author":"Wiegele","year":"2017","journal-title":"Semin. Thromb. Hemost."},{"key":"ref_11","unstructured":"Barmore, W., Bajwa, T., and Burns, B. (2022). Biochemistry, Clotting Factors. StatPearls, StatPearls Publishing."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.tmrv.2011.07.005","article-title":"Principles and practice of thromboelastography in clinical coagulation management and transfusion practice","volume":"26","author":"Bolliger","year":"2012","journal-title":"Transfus. Med. Rev."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Volod, O., Bunch, C.M., Zackariya, N., Moore, E.E., Moore, H.B., Kwaan, H.C., Neal, M.D., Al-Fadhl, M.D., Patel, S.S., and Wiarda, G. (2022). Viscoelastic Hemostatic Assays: A Primer on Legacy and New Generation Devices. J. Clin. Med., 11.","DOI":"10.3390\/jcm11030860"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1587","DOI":"10.1097\/TA.0b013e31828c3171","article-title":"Practical application of point-of-care coagulation testing to guide treatment decisions in trauma","volume":"74","author":"Voelckel","year":"2013","journal-title":"J. Trauma Acute Care Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1016\/j.jss.2020.01.013","article-title":"ROTEM as a Predictor of Mortality in Patients with Severe Trauma","volume":"251","author":"Smith","year":"2020","journal-title":"J. Surg. Res."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1016\/S0294-1260(01)00018-8","article-title":"Evaluation des facteurs pronostiques chez le patient br\u00fbl\u00e9","volume":"46","author":"Griffe","year":"2001","journal-title":"Ann. Chir. Plast. Esthet."},{"key":"ref_17","first-page":"e31550","article-title":"Medical and Surgical Care of Critical Burn Patients: A Comprehensive Review of Current Evidence and Practice","volume":"14","author":"Datta","year":"2022","journal-title":"Cureus"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"549","DOI":"10.1097\/BCR.0B013E318093DEF0","article-title":"Inhalation injury: Research progress and needs","volume":"28","author":"Palmieri","year":"2007","journal-title":"J. Burn. Care Res."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1186\/s13054-015-1077-4","article-title":"Diagnosis and management of inhalation injury: An updated review","volume":"19","author":"Walker","year":"2015","journal-title":"Crit. Care"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1097\/BCR.0B013E31802C889F","article-title":"Inhalation injury, pulmonary perturbations, and fluid resuscitation","volume":"28","author":"Endorf","year":"2007","journal-title":"J. Burn. Care Res."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Kim, Y., Kym, D., Hur, J., Yoon, J., Yim, H., Cho, Y.S., and Chun, W. (2017). Does inhalation injury predict mortality in burns patients or require redefinition?. PLoS ONE, 12.","DOI":"10.1371\/journal.pone.0185195"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"529","DOI":"10.1097\/BCR.0b013e3181e4d680","article-title":"Predicting prognosis in thermal burns with associated inhalational injury: A systematic review of prognostic factors in adult burn victims","volume":"31","author":"Colohan","year":"2010","journal-title":"J. Burn. Care Res."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"418","DOI":"10.1097\/00004630-198909000-00008","article-title":"Leukopenia in acute thermal injury: Evidence against topical silver sulfadiazine as the causative agent","volume":"10","author":"Thomson","year":"1989","journal-title":"J. Burn. Care Rehabil."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Laggner, M., Lingitz, M.T., Copic, D., Direder, M., Klas, K., Bormann, D., Gugerell, A., Moser, B., Radtke, C., and Hacker, S. (2022). Severity of thermal burn injury is associated with systemic neutrophil activation. Sci. Rep., 12.","DOI":"10.1038\/s41598-022-05768-w"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"563","DOI":"10.1111\/wrr.12053","article-title":"Endothelial necrosis at 1 hour postburn predicts progression of tissue injury","volume":"21","author":"Hirth","year":"2013","journal-title":"Wound Repair Regen."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"748","DOI":"10.1097\/01.sla.0000094441.38807.09","article-title":"Bone marrow failure following severe injury in humans","volume":"238","author":"Livingston","year":"2003","journal-title":"Ann. Surg."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1901","DOI":"10.1016\/j.burns.2019.07.014","article-title":"Natural kinetics of blood cells following major burn: Impact of early decreases in white blood cells and platelets as prognostic markers of mortality","volume":"45","author":"Osuka","year":"2019","journal-title":"Burns"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1016\/j.burns.2018.09.004","article-title":"Early clinical complete blood count changes in severe burn injuries","volume":"45","author":"Sen","year":"2019","journal-title":"Burns"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1284","DOI":"10.1097\/00003246-199209000-00015","article-title":"Hematologic changes in massive burn injury","volume":"20","author":"Lawrence","year":"1992","journal-title":"Crit. Care Med."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1097\/BCR.0b013e3181d0f618","article-title":"Anemia of thermal injury: Combined acute blood loss anemia and anemia of critical illness","volume":"31","author":"Gamelli","year":"2010","journal-title":"J. Burn. Care Res."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"494","DOI":"10.1097\/SHK.0000000000001890","article-title":"Prognostic Values of Platelet Distribution Width and Platelet Distribution Width-to-Platelet Ratio in Severe Burns","volume":"57","author":"Lin","year":"2022","journal-title":"Shock"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"806","DOI":"10.1016\/j.burns.2009.05.005","article-title":"The role of fibrinogen in aggregation of platelets in burn injury","volume":"36","author":"Levin","year":"2010","journal-title":"Burns"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1474","DOI":"10.1097\/TA.0b013e3182923193","article-title":"Major injury is not associated with acute traumatic coagulopathy","volume":"74","author":"Lu","year":"2013","journal-title":"J. Trauma Acute Care Surg."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1016\/j.injury.2012.05.010","article-title":"Early coagulopathy of major burns","volume":"44","author":"Mitra","year":"2013","journal-title":"Injury"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"206","DOI":"10.5005\/jp-journals-10071-23161","article-title":"Concept of lethal triad in critical care of severe burn injury","volume":"23","author":"Muthukumar","year":"2019","journal-title":"Indian J. Crit. Care Med."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1157","DOI":"10.1016\/j.burns.2013.02.010","article-title":"Acute burn induced coagulopathy","volume":"39","author":"Sherren","year":"2013","journal-title":"Burns"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1492","DOI":"10.1016\/j.burns.2014.04.011","article-title":"Lethal triad in severe burns","volume":"40","author":"Sherren","year":"2014","journal-title":"Burns"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"544","DOI":"10.1093\/jbcr\/irz178","article-title":"Incidence and prognostic value of acute coagulopathy after extensive severe burns","volume":"41","author":"Geng","year":"2020","journal-title":"J. Burn. Care Res."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"2652","DOI":"10.1097\/CCM.0b013e3182281af5","article-title":"Functional definition and characterization of acute traumatic coagulopathy","volume":"39","author":"Davenport","year":"2011","journal-title":"Crit. Care Med."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1016\/j.jss.2016.01.006","article-title":"Indepth analysis of clotting dynamics in burn patients","volume":"202","author":"Tejiram","year":"2016","journal-title":"J. Surg. Res."},{"key":"ref_41","first-page":"988","article-title":"Changes of fibrinogen and D-dimer in patients with severe burns and their relationship with prognosis","volume":"12","author":"Zhang","year":"2018","journal-title":"Chin. J. Prim. Med. Pharm."},{"key":"ref_42","first-page":"23","article-title":"Hypercoagulation and Hypermetabolism of Fibrinogen in Severely Burned Adults","volume":"41","author":"Martini","year":"2020","journal-title":"J. Burn. Care Res."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"2019","DOI":"10.1182\/blood-2014-06-528406","article-title":"von Willebrand factor biosynthesis, secretion, and clearance: Connecting the far ends","volume":"125","author":"Lenting","year":"2015","journal-title":"Blood"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"678","DOI":"10.1038\/nri2156","article-title":"Getting to the site of inflammation: The leukocyte adhesion cascade updated","volume":"7","author":"Ley","year":"2007","journal-title":"Nat. Rev. Immunol."},{"key":"ref_45","first-page":"31","article-title":"Measurement of von Willebrand factor as the marker of endothelial dysfunction in vascular diseases","volume":"9","author":"Horvath","year":"2004","journal-title":"Exp. Clin. Cardiol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1186\/s42077-021-00141-x","article-title":"Evaluation of von Willebrand factor as a marker for early diagnosis of Acute Respiratory Distress Syndrome in comparison to Interleukin-6","volume":"13","author":"ELfawy","year":"2021","journal-title":"Ain Shams J. Anesthesiol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1016\/j.jss.2021.12.049","article-title":"Assessing Factor V Antigen and Degradation Products in Burn and Trauma Patients","volume":"274","author":"Keyloun","year":"2022","journal-title":"J. Surg. Res."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1016\/j.burns.2021.03.004","article-title":"Early protein C activation is reflective of burn injury severity and plays a critical role in inflammatory burden and patient outcomes","volume":"48","author":"Zhao","year":"2022","journal-title":"Burns"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"280","DOI":"10.1093\/jbcr\/irac177","article-title":"Coagulation Alterations in Major Burn Patients: A narrative review","volume":"44","author":"Guilabert","year":"2022","journal-title":"J. Burn Care Res."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"4296","DOI":"10.1182\/blood-2012-07-292094","article-title":"In vivo roles of factor XII","volume":"120","author":"Schmaier","year":"2012","journal-title":"Blood"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1016\/j.burns.2010.12.004","article-title":"Fibrinogen function after severe burn injury","volume":"38","author":"Schaden","year":"2012","journal-title":"Burns"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1186\/s13049-016-0308-2","article-title":"A systematic review on the rotational thrombelastometry (ROTEM\u00ae) values for the diagnosis of coagulopathy, prediction and guidance of blood transfusion and prediction of mortality in trauma patients","volume":"24","author":"Veigas","year":"2016","journal-title":"Scand. J. Trauma Resusc. Emerg. Med."}],"container-title":["European Burn Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2673-1991\/6\/3\/37\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:57:33Z","timestamp":1760032653000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2673-1991\/6\/3\/37"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,24]]},"references-count":52,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2025,9]]}},"alternative-id":["ebj6030037"],"URL":"https:\/\/doi.org\/10.3390\/ebj6030037","relation":{},"ISSN":["2673-1991"],"issn-type":[{"value":"2673-1991","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,24]]}}}