Prognostic significance of glycemic control in burn injury patients: A study in Tertiary Care Hospital of Odisha

Abstract

Background: Thermal injury is associated with anatomic, physiologic, endocrinologic, and immunologic alterations, which require specialized care. Advances in medical care have changed the principal cause of death in burn patients from burn shock to wound sepsis. An intervention that has drastically changed this outlook is early excision and primary closure of wounds. We used insulin for glycemic control and attenuating systemic inflammation. Materials and Methods: Patients admitted to S. C. B Medical College hospital were divided into 2 groups of 34 each: control group (n = 34) which did not receive insulin and study group (n = 34) which received insulin. Serum C-reactive protein (CRP), fibrinogen, albumin white blood cell, and blood cultures were done every 7th day. Results: Albumin levels decreased over 7 days followed by gradual recovery which was faster in the study group. CRP levels rose and attained its peak by day 14, then declined. CRP peak in the study group was found to be lower than control. Fibrinogen levels showed identical trend as CRP. Leukocytosis was higher in control compared to study group. Blood culture positive was higher in control compared to study group; Pseudomonas and Candida were most common organisms, but study group patients were resistant to Candida. Out of 29 deceased patients, 55% were from control group. Conclusions: Insulin administration in severely burned patients has demonstrated benefits among various parameters. In critically ill burn injury patients, obtaining tight glycemic control with intensive insulin therapy was shown to reduce morbidity and mortality.