The impact of first-day levels of serum proteins and lipids and their subsequent trends as prognostic indicators of burn mortality

Abstract

Introduction: In severe burns, there is a profound systemic response that persists till the wounds heal. Since these physiological and metabolic derangements are dynamic over the clinical course of burns, it is expected that both trend of change and absolute values of the protein and lipid levels, to have a bearing on the prognosis and the ultimate outcome. Hence, this study was envisaged evaluate the prognostic value of these metabolic variables in burn patients. Materials and Methods: The study conducted on 100 adult patients of thermal burn (20% and 60% total body surface area). Serum albumin, globulin, total proteins, cholesterol and triglycerides (TGs) were estimated on alternate days starting from day till discharge or death. The 1st-day value and the trend of serial values throughout the clinical course were compared among nonsurvivors and survivors. Results: Mean serum values of albumin, globulin, and total protein on first-day of burns in survivor group were higher. Serum albumin levels of ≤2.1 g/dl at day one was a poor prognostic factor. The trend in the serum values of albumin, globulin, total protein, and cholesterol in survivor group was significantly positive and negative in nonsurvivors. Serum TGs, however, showed a nonsignificant negative trend in the survivors. Among the biochemical markers evaluated, most significant prognostic parameter was serum albumin, with maximum sensitivity and specificity. Conclusion: The cutoff values of proteins and trend of subsequent serial values can guide metabolic manipulations, albumin infusion, and dietary intake. In addition, these biochemical parameters merit inclusion in burn prognostic index scales.