Preliminary insights into systemic biomarkers associated with coagulopathy and endotheliopathy in a swine burn model and the impact of fresh frozen plasma resuscitation strategies

BACKGROUND: Burn injury is a form of trauma whose management may be further complicated in battlefield settings. Burn injury induces inflammation, coagulopathy, and endotheliopathy; however, the timing and progression of these responses have not been well established. Fresh frozen plasma (FFP) has been shown to modulate these responses in other trauma models, but its effects after burn injury remain poorly defined. This study aimed to profile these responses in a swine model of burn injury using a biomarker-based approach. METHODS: Anesthetized female Yorkshire crossbred swine (n = 15) were subjected to ~40% total body surface area mixed deep-partial to full thickness contact burns. At 0.5 h post-injury, swine were resuscitated with either crystalloid (lactated Ringer's Solution), crystalloid + early FFP, or crystalloid + continuous FFP. Blood samples were collected at baseline and serially over 24 h before euthanasia. Isolated serum/plasma samples were analyzed using ELISA-based assays to develop a biomarker profile of each treatment. RESULTS: Circulating concentrations of C-reactive protein, heparan sulfate, adhesion molecules, and activated protein C increased relative to baseline by 24 h after burn. Preliminary findings suggests that FFP resuscitation strategies have minimal impact on these markers relative to crystalloid alone. CONCLUSIONS: In a swine model of 40% total body surface area burn, injury induced inflammatory changes and endothelial activation during the first 24 h post-injury. Coagulation-related biomarkers showed limited change during the observation period and require further evaluation. In this exploratory study, FFP-containing resuscitation strategies were not associated with detectable differences in most biomarker responses relative to crystalloid alone. As an exploratory study, these findings require further investigation with a fully powered study. Future research should incorporate longer term observations and functional assays to further define the effects of burn injury and the efficacy of FFP to improve burn care.