Analysis of factors associated with mortality in major burn patients

Abstract

Objective: Major burn injury is a type of trauma with high morbidity and mortality rates at all age groups. There is no consensus on the provided guidelines regarding the prediction of severity of the victims. Not being accessible to sophisticated clinical and blood monitoring in developing countries, it remains a challenge for them. The aim of the present study was to analyze the factors that have an effect on mortality and serve as a guide for burn treatment. Factors affecting mortality in major burn patients treated in a burn treatment center of a third step hospital with over 30% of burns of the total body surface area were evaluated, and parameters indicating severity were specifically determined. Material and Methods: Medical records and follow-up notes of patients hospitalized in Ankara Numune Education and Research Hospital Burn Center between 2008 and 2014 were evaluated retrospectively. Data on age, gender, comorbidities, burn percentage, locality, type of burn, process of the burn (suicide or accident), presence of inhalation injury, results of blood hemogram and biochemical tests, length of hospitalization, type of surgical procedures performed, presence of multitrauma, and ventilatory support requirement were analyzed to determine the factors affecting mortality. White blood cell count, hemoglobin count, platelet count, and lactate dehydrogenase level were examined at admission, at the middle of the clinical course, and at the end of treatment (at both exitus date or discharge date). Results: A total of 224 patients were hospitalized with burns ≥ 30% total body surface area. Of the 224 patients, 81.7% were males, and 18.4% were females. In the mortality group, 41.3% were males, and 58.5% were females. Gender (female, p< 0.041), age (p< 0.001), age group (0-14/15-59/> 60 years, p< 0.001), total body surface area (p< 0.001), type of burn (flame, p< 0.002), presence of inhalation injury (p< 0.001), process of the burn (p< 0.002), time spent between the event and admission to the hospital (p< 0.001), length of hospitalization (p< 0.001), presence of comorbidity (p< 0.038), diabetes mellitus (p< 0.05), ventilation support (p< 0.001), lactate dehydrogenase values (lactate dehydrogenaseadmission, p< 0.001; lactate dehydrogenasemiddle, p< 0.015; lactate dehydrogenaselast, p< 0.001), white blood cell count (p< 0.001), and platelet count (p< 0.043) were found to be significant for univariate analyses. These parameters were further evaluated using multivariate analyses. Lactate dehydrogenaselast level (p< 0.001), age (p< 0.001), length of hospitalization (negative odds ratio), p< 0.001), presence of inhalation injury (p< 0.029), total body surface area burned (p< 0.029), and leukocytosis (p< 0.006) were found to be significantly associated with mortality; however, leukocytosis and length of hospitalization did not pose risk for mortality with regard to odds ratios. Conclusion: Early recognition of the factors affecting morbidity and mortality in patients and taking preventive measures, in addition to earlier de...

Trajectories of longitudinal biomarkers for mortality in severely burned patients

“…The significant difference in lactate levels was observed before 19 days in the simple mean plot but before 33 days before death in the fitted model because lactate reflects the severity of burns and the mortality risk 7 . For WBC count, a well-known predictor of sepsis and mortality among burn patients 8 , no difference was observed between the two groups in the forward manner (p = 0.537) and showed a decreasing trend, but we could infer that the resolution of leukocytosis is necessary to survive. www.nature.com/scientificreports/ Creatinine, which is a known predictor of AKI, is a predictor of mortality in burns 9 .…”

Therapeutic Outcome of Burn Patients Treated With Hyperbaric Oxygen

“…The high rate of morbidity and mortality in burns has yielded poor outcomes in patients of all age groups. As stated by Guldogan et al, the mortality rate after thermal burns (>30% total body surface area [TBSA]) was the highest of any burn type at 44.2% of 224 patients [ 21 ]. The use of adjunctive HBOT in burns has sought to determine its significance to reduce morbidity and mortality rates effectively.…”

Factors affecting mortality in burns: a single center study

“…(Table 1) This was observed in many other studies. [1][2][3] Aged patients are more prone to developing complications as well as have higher incidence of increased BSA. The metabolic response to injury weakens with advancing age, thereby weakening the immune response as well as increased susceptibility to infection.…”

“…The metabolic response to injury weakens with advancing age, thereby weakening the immune response as well as increased susceptibility to infection. 1,2 Aged patients also have increased difficulty in protecting themselves at the time of injury, thereby predisposing to increased BSA and poor outcomes. 3…”