Candida Antigen Titer Elevation and Mortality in Burn Patients

Rolf Lefering,Sebastian Jachec,Paul-Christian Fuchs,Walter Perbix,Christian Weinand

doi:10.29252/wjps.8.1.18

Abstract

Mortality in burn patients has several contributing factors as sex, age, degree of burns, or inhalation injuries. Usefulness of Candida antigen (CAG) titer is still being under debate to predict mortality. This study assessed correlation between CAG titer and mortality in burn patients.From 1988 to 2011, 877 burn intensive care patients were evaluated for age, sex, total burn surface area (TBSA), multi organ failure (MOF), burn depth, escharotomy, fasciotomy, antibiotic use, co-morbidities, CAG titer and intubation.From 870 admitted patients, 190 patients were not enrolled. Increasing age was correlated with a higher mortality. The abbreviated burn severity index (ABSI) score of the deceased was 4 points and the TBSA was 20% higher than the survivors. The correlation for age, intubation, TBSA, inhalation injury, MOF, CAG titer, antibiotic use and escharotomy was significant. An increasing mortality was noted with antibiotic use and a CAG titer of 1:8 and higher. CAG titer of 1:8 and higher had a sensitivity of 51.1% and specificity of 86.3% for mortality. Multivariate analysis confirmed high influence of older age, MOF, comorbidities, antibiotic use and CAG titer of 1:8 and higher on mortality. There was a significant correlation for sex, younger age and CAG titer.CAG titers of 1:8 and higher might warrant beginning of antimycotic treatment in elderly patients with high TBSA to avoid increase in mortality.

Highlights

Mortality of burn injuries increases with higher total burned surface area and occurring infections.[1]
From 1988 to 2011, 877 burn intensive care patients were evaluated for age, sex, total burn surface area (TBSA), multi organ failure (MOF), burn depth, escharotomy, fasciotomy, antibiotic use, comorbidities, Candida antigen (CAG) titer and intubation
The abbreviated burn severity index (ABSI) score of the deceased was 4 points and the TBSA was 20% higher than the survivors

Summary

Introduction

Mortality of burn injuries increases with higher total burned surface area and occurring infections.[1] Burn patients are susceptible to infections, because of the loss of the natural skin barrier and immuno-compromise. Burn size and defect are proportionate with odds of suspecting an infection.[2] As bacterial www.wjps.ir /Vol.8/No.1/January 2019 infections can be detected with relative ease, suspicion of existing fungemia is found to be high in burn patients because of the existing immune suppression.[3] Before the use of PCR or real-time PCR, CAG titer was widely used for detection of candidemia and showed its impact on finding the diagnosis. Current nonculture methods rely on a polymerase chain reaction (PCR) assay for candidemia.[4]

Methods

Results

Conclusion