Early Detection and Kinetics of Sepsis-Induced Coagulopathy in Severe Burn Patients

Background and Rationale:

Severe burn trauma triggers a profound systemic inflammatory response that interacts closely with the hemostatic system. When complicated by sepsis, patients rapidly develop microvascular thrombosis and consumption coagulopathy, leading to multi-organ failure and death. Standard diagnostic criteria for disseminated intravascular coagulation often lack sensitivity during the initial hyperinflammatory phase. The JAAM-2 score incorporates platelet counts (or kinetic drop), prothrombin time/INR, and D-dimer/FDP levels without relying on systemic inflammatory response syndrome (SIRS) criteria, making it a promising tool for early detection in burn ICU settings. Study Objectives:Primary Objective: To evaluate the diagnostic accuracy and early kinetic evolution (Day 0 to Day 10) of the JAAM-2 score for identifying sepsis-induced coagulopathy in adult severe burn patients. Secondary Objectives:Compare the diagnostic performance of the JAAM-2 score against the ISTH "Overt DIC" and ISTH-SIC scores. Assess the predictive value of baseline (Day 0) and H48 JAAM-2 scores for organ dysfunction progression (SOFA score) and clinical sepsis non-control at Day 7. Evaluate the association between kinetic trajectories of the JAAM-2 score and 28-day all-cause mortality. Validate the diagnostic performance of immunothrombotic ratios (neutrophil-to-lymphocyte ratio [NLR] and platelet-to-lymphocyte ratio [PLR]) during the initial septic phase. Study Design and Workflow:

This is a prospective, single-center, observational cohort study conducted in a specialized Burn Intensive Care Unit. Eligible adult patients (≥18 years) with thermal burns covering >20% TBSA diagnosed with a first episode of sepsis (according to American Burn Association 2007 criteria) will be included. Data collection occurs at specific time points: Baseline (Day 0 / T0), H48 (Day 2), Day 4, Day 6, Day 8, and Day 10. Baseline Assessment (Day 0): Demographics (age, sex), burn characteristics (% TBSA, smoke inhalation), burn severity scores (ABSI, UBS), and delay between burn injury and sepsis onset. Serial Biological and Clinical Monitoring (D0, H48, D4, D6, D8, D10):Organ failure assessment: Sequential Organ Failure Assessment (SOFA) score, vasopressor requirements (norepinephrine maximum dose), and mechanical ventilation parameters. Coagulation panel: Platelet count, Prothrombin Time (PT / INR), D-dimers (or FDP), and Fibrinogen. Inflammatory and hematological markers: Leukocytes, Absolute Neutrophil Count, Absolute Lymphocyte Count, NLR, and PLR. Coagulopathy scores: Simultaneous calculation of JAAM-2, ISTH "Overt DIC", and ISTH-SIC scores. Day 7 Evaluation: Assessment of clinical sepsis control status (controlled vs. uncontrolled, defined by persistent septic shock requiring norepinephrine or emergency surgical source control). Day 28 Follow-up: Vital status (alive/deceased), total duration of mechanical ventilation, ICU length of stay, and occurrence of major thrombotic (deep vein thrombosis / pulmonary embolism) or major bleeding events.