Severe burn injury: Body Mass Index and the Baux score

Saadat, Ghulam H; Toor, Rubinder; Mazhar, Faizan; Bajani, Francesco; Tatebe, Leah C; Schlanser, Victoria; Kaminsky, Matthew; Messer, Thomas; Starr, Frederic; Dennis, Andrew; Poulakidas, Stathis; Bokhari, Faran

doi:10.1016/j.burns.2020.10.017

Cited by 10 publications

(4 citation statements)

References 12 publications

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“…22 BMI alone does not provide information on the amount, type and location of adiposity. 23 Ideally, to improve accuracy, anthropometric measures could be used to estimate and differentiate the body composition of a patient. An obesity scale including waist circumference along with age, race and gender may better evaluate a patient's metabolic risk.…”

Section: Discussionmentioning

confidence: 99%

The obesity paradox in patients with major burn injuries: a single tertiary burn centre review

Pollock,

Paul,

2024

Australas J Plast Surg

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Introduction: The obesity paradox is a phenomenon described in medical literature where overweight and obese patients have improved survival and better health outcomes. The obesity paradox is of curiosity to many clinicians as the general consensus in medicine has been that a higher body mass index results in poorer health outcomes in both medical and surgical conditions. The aim of this study is to determine whether the obesity paradox exists in our patients with major burn injuries. To our knowledge, this has not been previously investigated in the Australian major burn population. Methods: This is a retrospective study involving patients with major burn injuries > 20 per cent total body surface area admitted to the Victorian Adult Burns Service (Melbourne, Australia) from 1 January 2016 to 31 December 2020 (five-year period). Information collected included patient demographics, weight and height, and nature of burn injuries. Primary outcome of interest was inpatient mortality, and secondary outcomes included hospital length of stay, intensive care unit length of stay, duration of ventilation support required and presence of bacteraemia. Results: A total of 1704 patients were admitted, of whom 165 patients met inclusion criteria for analysis. The vast majority of 31 patients (18.8%) who died during admission were palliated. The obesity paradox did not exist in this study population. Furthermore, although not statistically significant, higher levels of body mass index showed increased risk of mortality. There was no significant association between body mass index and hospital length of stay (p = 0.16), intensive care unit length of stay (p = 0.72), duration of ventilation support (p = 0.62) nor bacteraemia (p = 0.68). Conclusion: The emerging evidence regarding the obesity paradox in the burn surgery literature is inconsistent. We contend that differences in burn management, including palliation of patients with major burn injuries, contribute to these findings.

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Section: Discussionmentioning

confidence: 99%

The obesity paradox in patients with major burn injuries: a single tertiary burn centre review

Pollock,

Paul,

2024

Australas J Plast Surg

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“…We confirmed that the nomogram was an independent prognostic value in multivariate logistic analysis. TBSA, ABSI, and Baux were often used to assess the severity and prognosis of burn patients ( 48 , 49 ). Some researchers have also constructed prognostic models related to age, gender, length of hospital stay, and inhalation injury.…”

Section: Discussionmentioning

confidence: 99%

Machine learning links different gene patterns of viral infection to immunosuppression and immune-related biomarkers in severe burns

Wang¹,

Zhang²,

Lin³

et al. 2022

Front. Immunol.

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IntroductionViral infection, typically disregarded, has a significant role in burns. However, there is still a lack of biomarkers and immunotherapy targets related to viral infections in burns.MethodsVirus-related genes (VRGs) that were extracted from Gene Oncology (GO) database were included as hallmarks. Through unsupervised consensus clustering, we divided patients into two VRGs molecular patterns (VRGMPs). Weighted gene co-expression network analysis (WGCNA) was performed to study the relationship between burns and VRGs. Random forest (RF), least absolute shrinkage and selection operator (LASSO) regression, and logistic regression were used to select key genes, which were utilized to construct prognostic signatures by multivariate logistic regression. The risk score of the nomogram defined high- and low-risk groups. We compared immune cells, immune checkpoint-related genes, and prognosis between the two groups. Finally, we used network analysis and molecular docking to predict drugs targeting CD69 and SATB1. Expression of CD69 and SATB1 was validated by qPCR and microarray with the blood sample from the burn patient.ResultsWe established two VRGMPs, which differed in monocytes, neutrophils, dendritic cells, and T cells. In WGCNA, genes were divided into 14 modules, and the black module was correlated with VRGMPs. A total of 65 genes were selected by WGCNA, STRING, and differential expression analysis. The results of GO enrichment analysis were enriched in Th1 and Th2 cell differentiation, B cell receptor signaling pathway, alpha-beta T cell activation, and alpha-beta T cell differentiation. Then the 2-gene signature was constructed by RF, LASSO, and LOGISTIC regression. The signature was an independent prognostic factor and performed well in ROC, calibration, and decision curves. Further, the expression of immune cells and checkpoint genes differed between high- and low-risk groups. CD69 and SATB1 were differentially expressed in burns.DiscussionThis is the first VRG-based signature (including 2 key genes validated by qPCR) for predicting survival, and it could provide vital guidance to achieve optimized immunotherapy for immunosuppression in burns.

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“…of severe burns patients in this study. Previous studies have reported that risk factors associated with mortality included TBSA, body mass index, inhalation injury, and some serious complications (23)(24)(25)(26). Considering the effects of PCCO monitoring on reducing burn-related complications of enrolled patients in this study, we proposed a hypothesis that it could also reduce mortality to a certain extent.…”

Section: Discussionmentioning

confidence: 99%

Fluid resuscitation based on pulse contour cardiac output monitoring is associated with improved prognosis in adult severe burn patients: a retrospective cohort study

Zhu¹,

Yang²,

Ding³

et al. 2021

Ann Palliat Med

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Background: A monitoring method is needed to further guide fluid resuscitation in severe burn injury. This study was performed to investigate the effects of pulse contour cardiac output (PCCO) monitoring on the prognosis of adult severe burns patients. Methods:We conducted a retrospective study enrolling patients from January 2015 to December 2020, who were divided into a control group receiving conventional monitoring and a study group receiving PCCO monitoring. The primary outcomes were 28-day mortality and total mortality, and the secondary outcomes included burn-related complications and the length of hospital stay and ICU stay. Multivariable logistic regression analysis and linear regression analysis were performed to determine the risk factors of burnsrelated complications and length of hospital stay in enrolled patients.Results: A total of 109 patients in the control group and 82 patients in the study group were enrolled. While the area of full thickness burn was much higher in the control group than in the study group (P=0.021), no significant difference was found in other characteristics between the two groups. During fluid resuscitation, the fluid volume ratio of the study group was significantly different from that of the control group, and both in the first 24 hours and the second 24 hours, the resuscitation fluid volume ratio and colloid volume ratio was significantly higher in the control group than in the study group (all P<0.001). Eight patients died during treatment, and there were more patients experiencing AKI and ARDS in the control group than in the study group (P=0.029 and 0.016). The lengths of hospital stay and ICU stay in the study group was much shorter than in the control group (P<0.001 and 0.005). In addition, TBSA was an important risk factor for both AKI and ARDS, and the existence of inhalation injury and older age increased the incidence of ARDS. Higher TBSA, inhalation injury, and burn-related complications were related to longer hospital stay in enrolled patients.Conclusions: Fluid resuscitation according to PCCO monitoring can effectively reduce the volume of colloid and overall fluid volume and reduce the incidence of burns-related complications and shorten the length of hospital stay.

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Severe burn injury: Body Mass Index and the Baux score

Cited by 10 publications

References 12 publications

The obesity paradox in patients with major burn injuries: a single tertiary burn centre review

The obesity paradox in patients with major burn injuries: a single tertiary burn centre review

Machine learning links different gene patterns of viral infection to immunosuppression and immune-related biomarkers in severe burns

Fluid resuscitation based on pulse contour cardiac output monitoring is associated with improved prognosis in adult severe burn patients: a retrospective cohort study

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