Dr Thomas Lang1,2,3,4, Dr Albert Kim4, Dr Aruna Wijewardena4, Mr Ruilong Zhao1,2, Ms Rachel McGrath2,4, Dr Siobhan Fitzpatrick4, Dr Nancy Huang4, Dr John Vandervord2,4, Professor Gregory Fulcher2,4, Professor Christopher Jackson1,2
1The Kolling Institute, St. Leonards, Australia, 2The University of Sydney, Camperdown, Australia, 3St. George Hospital, Kogarah, Australia, 4Royal North Shore Hospital, St. Leonards, Australia
Activated protein C (APC) is a naturally occurring anticoagulant with potent cytoprotective and anti-inflammatory effects. Recent evidence indicates that APC heals recalcitrant wounds through stimulation of angiogenesis and re-epithelialisation. Low levels of protein C (PC) are associated with, and may predispose to, foot ulcers in diabetic patients, irrespective of glucose control. Whether there is a relationship between PC and burn injury, and subsequent healing is unknown.
This is a longitudinal study to measure plasma PC levels in patients with acute severe partial thickness burns throughout their hospital admission.
Ethics approval was gained for the enrolment of 90 patients admitted to the Royal North Shore Hospital Severe Burns Unit with partial thickness burns affecting 10-80% of the total body surface area. Plasma levels of PC were measured every three days for three weeks.
The level of plasma PC in burn patients on day of admission (Day 0) was 75.8±3.0% (n=47, mean±SEM), with a range of 34–125%, compared to the normal range of 80–180%. The proportion of patients with serum PC level <80% at baseline was 57.4% (n=27). PC levels increased over time (n=38 in each group, p<0.0001, Friedman analysis): day 0 (76.4±3.4%) vs day 3 (91.2±4.4%) vs day 6 (106.1±5.4%). Of the patients completed to date, further significant increases have occurred until day 18.
Burns patients have wide-ranging but overall low plasma PC on admission, which increases over time. Whether the PC level on admission is predictive of outcome is currently under investigation.
Thomas is a Resident Medical Officer from Sydney completing a Master of Philosophy (Research) at the University of Sydney in conjunction with The Kolling Institute and Royal North Shore Hospital Severe Burns Unit. This is his second visit to The Adelaide Oval, after attending Australia’s first day-night test match against New Zealand.