Mortality In Burn Patients Research Articles

Serum Albumin and Interleukin 6 Levels as Risk Factors of Morbidity and Mortality in Burn Patients

Serum Albumin and Interleukin 6 Levels as Risk Factors of Morbidity and Mortality in Burn Patients

Admission neutrophil-to-lymphocyte ratio to predict mortality in burn patients: a meta-analysis.

The neutrophil-to-lymphocyte ratio (NLR) proves to be a convenient and cost-effective marker with studies showing that a high NLR can serve as a mortality indicator in burn cases. We conducted a meta-analysis aiming to explore whether on-admission NLR values could serve as predictors of mortality in burn patients. PubMed, Web of Science, Scopus and Embase were searched from inception until January 2024. We included all studies investigating burn patients that contain information on the NLR value at the time of hospital admission and mortality outcomes. The studies were critically appraised using the NIH Quality Assessment Tool. Nine studies fulfilled our criteria with a total population of 1837 participants, including 1526 survivor Burn patients and 311 non-survivor Burn patients. The overall mean difference measured by random model showed a significant increase in NLR by 5.06 (95% CI 3.42, 6.68) p ≤ 0.001 for the non-survivor group over the survivors group with heterogeneity I2 = 67.33%, p ≤ 0.001. A meta-regression was done to investigate the potential source of heterogeneity among studies. The results showed that age (p = 0.394), gender (p = 0.164), and sample size (p = 0.099) did not contribute to the source of heterogeneity, however, the burn surface area contributed significantly (p = 0.002). A leave-one-out meta-analysis was done, showing that omitting Le Qui et al., leads to significantly decrease the heterogeneity to be I2 = 2.73%. Meta-regression repeated to assess the burn surface area again to be found noncontributing (p = 0.404). Our findings support that elevated NLR values can serve as a mortality indicator in burn cases. This will have a great clinical impact by aiding in stratifying the burn patients on admission.

Effect of X-ray radiation on Multi-drug Resistant (MDR) Enterobacteriaceae & P.aeruginosa isolated from burn unit patient. The phenotypic and molecular study, Biofilm formation

Background: Multi-drug-resistant (MDR) bacteria are a significant global health concern due to their elevated rates of morbidity and mortality in burn patients. In This study investigated the presence of multidrug-resistant pathogenic bacteria in individuals with burn injuries, the formation of biofilms, and the impact of X-ray radiation. Method: For this study Clinical swabs about120 burn patients were obtained between December 2023 and June 2024 from burn units at Ramadi and Falluja Teaching Hospitals. Both conventional and Vitek2(bioMérieux) methods were used to identify the bacterial isolates. The isolates were then divided into three multi-drug resistance groups. The Colorimetric method (MTP) detected biofilms. To detect blaOXA-23,blaOXA-48, Omp, and blaTEM resistance genes, multiplex PCR was used. This research used two lumbosacral spine X-ray levels. Two levels of radiation were used 40 (80KV) mAs and 51.2 (85KV). Result: Results of burn isolation revealed 30(27%) P.aeruginosa, 18(16%) k.pneumoniae, 7(6%) E.coli, 7(6%) P.mirabilis. Of the all isolates, 100% produced biofilm. The Multiplex-PCR analysis revealed that the blaTEM genes were the predominant ones, constituting 30% of the samples. Subsequently, blaOXA-23 constituted 24.5% of the cases, whereas Omp accounted for 22.7% and blaOXA-48 for 13.6%. The radiation impact of X-rays produced by two dosages, 40(80KV)mAs for 125msec and 51,2(85KV) mAs for 160msec, demonstrates that there is no effect or alteration in the resistance capacity of all the bacterial isolates tested. Conclusion: This study showed that burn unit isolates produce ESBLs, which is a major concern in the intensive care unit due to its high morbidity and potential mortality. These data match antibiotic phenotypic test results showing substantial cefepime resistance. All isolates forming biofilms, this may association with high pathogenicity. This demands quick intervention to manage nosocomial outbreaks. No X-ray effect was seen on susceptibility a burn unit bacterial isolate.

Burn Injury in Obesity: Examination of the Burn Care Quality Platform’s (BCQP) Available Data on Obese Patients to Determine Burn Related Outcomes

IntroductionLiterature examining the impact of obesity in burn injury remains mixed. Previous examination of the National Burn Repository, now the BCQP, in obesity-related burn research is limited. The aim of this work was to provide an assessment of the BCQP dataset to examine the effect of obesity on burn-related outcomes. Materials and MethodsA retrospective review of the BCQP dataset from 2015-2018 was conducted. The primary outcome measure was mortality. Secondary outcomes included overall length of stay (LOS), ICU LOS, and total hospital costs. Patients were grouped as obese or non-obese and further stratified by total body surface area burn (TBSA) size for comparison purposes. Multiple logistic regression (MLG) was used to compare the effect of several independent variables on mortality, ICU LOS >7days, hospital LOS >10 days and total hospital costs >$200,000. ResultsOf 41,031 patients in the analysis, 3,845 (9.37%) were obese. Obese patients had a higher mean TBSA (p=0.01), longer overall LOS (p<0.001), ICU LOS (p<0.001) and total hospital costs (p<0.001). MLG found obesity to an independent predictor of ICU LOS >7 days, hospital LOS >10 days and total hospital costs >$200,000. Obesity was not an independent predictor of mortality in burn patients even stratified by burn size. ConclusionsThe presence of obesity in this dataset was not found to be a predictor of mortality for any burn size, but was a predictor of overall LOS, ICU LOS, and total hospital costs. Including obesity-related parameters in databases may improve analysis in obesity-related burn research.

Epidemiological characteristics and outcomes of special-cause burns: analysis of 33,619 burn patients in a major regional burn center in China from 2004 to 2021

Special-cause burn injuries are usually more severe and difficult to manage, and often contribute to a high mortality in severely injured patients. The aim of this study was to present the epidemiological characteristics of special-cause burn in a major regional burn center in China between 2004 and 2021 and determine the risk factors associated with the mortality of burn patients. A total of 33,619 burn patients were included the study, among which 4,452 (13.2%) were special-cause burn patients. Compared to the thermal burn group, the special-cause burn patients were usually male, elder, married and III-IV degree of burn with onset of upper extremity in summer and autumn. Moreover, a greater proportion of patients in the special-cause burn group underwent surgical treatment and amputation and had a higher median hospital stay and treatment costs. During the multivariate logistic regression, older age, male, unmarried, winter, III-IV degree of burn, ≥ 3 burn sites, and larger total body surface area (TBSA) of burn were significantly associated with higher burn mortality (all P < 0.05), however, patients with special-cause burn injuries have not increased odds for mortality (P > 0.05). These results suggested that special cause-burn patients suffer more severe injuries, resulting in longer hospital stays and higher health care expenditures, but it did not significantly increase the mortality risk. Therefore, burn clinicians should not only have the responsibility to cure burns, but also need to know and popularize burn epidemiological characteristic and precaution.

Meta-Analysis of the Global Mortality Rate Due to Infection in Burn Patients Admitted for Plastic Surgery.

Burn patients are generally prone to infection, which causes the patient's condition to be even worse. However, there is no study regarding the difference between the mortality rate of infected and non-infected patients. Therefore, the aim was to identify and compare the global mortality rate between infected and non-infected patients who were admitted to plastic surgery units. We searched PubMed, ScienceDirect, and Google Scholar and finally included five articles for this meta-analysis.We determined the odds ratio (OR) value by forest plot and assessed the study bias by a funnel plot. We also analyzed the quality and heterogeneity. The OR was determined as 0.43 (95%CI: 0.07-2.60), indicating a higher mortality rate in infected burn patients as compared to non-infected patients. The funnel plot showed no significant study bias. The quality of the studies was assessed high as well, and the heterogeneity was determined significant (I2>75%). The sensitivity analysis with the fixed effect model reconfirmed our main outcome. However, as a study limitation, we could not specifically determine the impact of strain-specific infection on the mortality rate and could not find more relevant research regarding this issue. We conclude that the overall non-infected burn patient mortality rate is lower as compared to the infected burn patients; however, non-infected patients can be prone to death if the burn degree is higher, the respiratory organ is injured, or the treatment is poor or delayed.

Delayed admission to hospital with proper prehospital treatments prevents severely burned patients from sepsis in China: A retrospective study

BackgroundSepsis is one of the major causes of morbidity and mortality in burn patients. However, the optimal timing of admission which can minimize the probability of sepsis is still unclear. This study aims to determine the optimal time period of admission for severely burned patients and find out the possible reasons for it. Method185 victims to the Kunshan factory aluminum dust explosion accident, which happened on August 2nd, 2014, were studied. The optimal cutpoint for continuous variables in survival models was determined by means of the maximally selected rank statistic. Univariate and multivariate analyses were further conducted to verify that admission time was not a risk factor for sepsis. Subgroup analyses were performed to find out possible contributing factors for the result. ResultThe cutoff point for admission time was determined as seven hours, which was supported by the survival curve (p < 0.001). Multivariate analysis showed that, in our study population, delayed admission time was not a risk factor for sepsis (HR = 0.610, 95 %CI = 0.415 - 0.896, p = 0.012). Subgroup analyses showed that “Tracheotomy before admission” (p = 0.002), “Whole blood transfusion” (p < 0.001), “Hemodynamic instability before admission” (p = 0.02), “Has a burn department in the hospital” (p = 0.009), “Has a burn ICU in the hospital” (p < 0.001), “Acute heart failure (AHF)” (p = 0.05), “acute respiratory distress syndrome (ARDS)” (p = 0.05) and “GI bleeding” (p = 0.04) were all statistically significant. ConclusionIn our study population, we found that delayed admission time was not a risk factor associated with a reduced incidence of sepsis among severely burned patients. This might be attributed to variations in prehospital treatments (whole blood transfusion and tracheotomy), whether the hospital had a burn department/ICU, and certain complications (AHF, ARDS and GI bleeding). It can be inferred that early prehospital care plays a crucial role in reducing sepsis risk among severe burn patients.

Multidrug-Resistant Organisms Infection on Mortality of Burn Patients at Public Hospital X in Jakarta: A Retrospective Study

Multidrug-Resistant Organisms Infection on Mortality of Burn Patients at Public Hospital X in Jakarta: A Retrospective Study

Effect of collagen hydrogel containing Lavandula officinalis essential oil nanoemulsion in wound healing of infectious burn.

The main cause of mortality in burn patients is infection from burns. Drug-resistant bacteria are the main causes of wound infection, so alternative antibiotic therapies hold significant importance. The objective of this study was to examine the impact of a collagen hydrogel that contains a nanoemulsion of Lavandula essential oil on the healing process of infected burn wounds. In this experimental study, 20 rats were randomly divided after applying burns with a 10 mm diameter hot plate and infecting the wounds with multidrug-resistant Pseudomonas aeruginosa into four groups, including a positive control, a negative control, the first experiment (collagen hydrogel), and the second experiment (collagen hydrogel containing Lavandula essential oil nanoemulsion). On the 4th, 11th, and 18th days, tissue samples were taken for pathology studies. The important parameters in burn wound healing with hematoxylin and eosin and Masson's trichrome staining methods were investigated and scored according to Abramov's method. Based on the pathology findings, experimental groups 1 and 2 compared to the negative and positive control groups were effective in rat infection wound healing. The hydrogel scaffold in the experimental groups increased fibroblasts and angiogenesis compared to the control groups. Epithelization was noticed only in the hydrogel group containing nanoemulsion. The study findings suggest that the use of collagen hydrogel with Lavandula essential oil nanoemulsion has potential as a wound dressing. This is because it has the potential to effectively promote healing and act as an antibacterial agent to prevent infections.

High-Intensity Blue Light (450-460 nm) Phototherapy for Pseudomonas aeruginosa-Infected Wounds.

Background: Nosocomial wound infection with Pseudomonas aeruginosa (PA) is a serious complication often responsible for septic mortality of burn patients. High-intensity antimicrobial blue light (aBL) treatment may represent an alternative therapy for PA infections. Methods: Antibacterial effects of an light-emitting diode (LED) array (450-460 nm; 300 mW/cm2; 15/30 min; 270/540J/cm2) against PA were determined by suspension assay, biofilm assay, and a human skin wound model and compared with 15-min topically applied 3% citric acid (CA) and wound irrigation solution (Prontosan®; PRT). Results: The aBL reduced the bacterial number (2.51-3.56 log10 CFU/mL), whereas PRT or CA treatment achieved a 4.64 or 6.60 log10 CFU/mL reduction in suspension assays. The aBL reduced biofilm formation by 60%-66%. PRT or CA treatment showed reductions by 25% or 13%. In this study, aBL reduced bacterial number in biofilms (1.30-1.64 log10 CFU), but to a lower extent than PRT (2.41 log10 CFU) or CA (2.48 log10 CFU). In the wound skin model, aBL (2.21-2.33 log10 CFU) showed a bacterial reduction of the same magnitude as PRT (2.26 log10 CFU) and CA (2.30 log10 CFU). Conclusions: The aBL showed a significant antibacterial efficacy against PA and biofilm formation in a short time. However, a clinical application of aBL in wound therapy requires effective active skin cooling and eye protection, which in turn may limit clinical implementation.

High-Intensity Blue Light (450-460 nm) Phototherapy for Pseudomonas aeruginosa-Infected Wounds.

Background: Nosocomial wound infection with Pseudomonas aeruginosa (PA) is a serious complication often responsible for the septic mortality of burn patients. Objective: High-intensity antimicrobial blue light (aBL) treatment may represent an alternative therapy for PA infections and will be investigated in this study. Methods: Antibacterial effects of a light-emitting diode array (450-460 nm; 300 mW/cm2; 15/30 min; 270/540 J/cm2) against PA were determined by suspension assay, biofilm assay, and a human skin wound model and compared with 15-min topically applied 3% citric acid (CA) and wound irrigation solution (Prontosan®; PRT). Results: aBL reduced the bacterial number [2.51-3.56 log10 colony-forming unit (CFU)/mL], whereas PRT or CA treatment achieved a 4.64 or 6.60 log10 CFU/mL reduction in suspension assays. aBL reduced biofilm formation by 60-66%. PRT or CA treatment showed reductions by 25% or 13%. Here, aBL reduced bacterial number in biofilms (1.30-1.64 log10 CFU), but to a lower extend than PRT (2.41 log10 CFU) or CA (2.48 log10 CFU). In the wound skin model, aBL (2.21-2.33 log10 CFU) showed a bacterial reduction of the same magnitude as PRT (2.26 log10 CFU) and CA (2.30 log10 CFU). Conclusions: aBL showed a significant antibacterial efficacy against PA and biofilm formation in a short time. However, a clinical application of aBL in wound therapy requires effective active skin cooling and eye protection, which in turn may limit clinical implementation.

The THE CORRELATION OFBODY MASSINDEX AND POST-RESUSCITATION ALBUMIN LEVELS WITHTHE MORTALITY OF BURNPATIENTS AT PROFNGOERAH GENERAL HOSPITAL PERIOD 2020-2022

Background: Burn injuries are associated with high mortality and morbidity. The incidence of death resulting from burns can be influenced by various prognostic factors, with nutritional status being a significant contributor. Therefore, assessing nutritional status through the calculation of body mass index (BMI) and post-resuscitation albumin levels becomes imperative.&#x0D; Purpose: This study aims to explore the correlation between BMI and post-resuscitation albumin levels with the mortality of burn patients at Prof Ngoerah General Hospital during the period 2020-2022.&#x0D; Methods: This research adopts an observational analytical approach, utilizing a cross-sectional research design and consecutive sampling techniques. The study relies on secondary data, specifically medical records of burn patients. Out of a total of 134 medical records, 100 were selected based on adherence to inclusion and exclusion criteria.&#x0D; Results: The study reveals median values for age (42.5), BMI of 23.9 and albumin levels 24 hours post resuscitation recorded at 2.235. The Spearman test analysis conducted on 100 samples reveals a notable correlation between these variables and the mortality of burn patients (r = 0.263; PR 1.707; 95% CI 1.163 – 2.504; p = 0.008). The chi-square test analysis regarding the association between post-resuscitation albumin levels and burn patient mortality also demonstrates a significant relationship (PR 2.390; 95% CI 1.358 – 4.207; p = 0.000).&#x0D; Conclusion: In conclusion, there is a statistically significant association between mortality and both BMI and post-resuscitation albumin levels among burn patients treated at the Prof Ngoerah General Hospital during the period 2020-2022.&#x0D; Keywords: Post resuscitation albumin, mortality, BMI, burns

Tele-rehabilitation to the improvement of the quality of burns clinical care

Burns are known as one of the most important causes of mortality in burn patients [1-6]. Adoption of appropriate diagnostic and treatment processes can lead to reducing the death rate of burn patients. Improperly management of burns victims can lead to physical abnormalities, psycho-social challenges, multiple surgeries, amputations, and functional disorders [7-17]. However, there is a perceived need for better, more precise, and longer rehabilitation due to the rising number of burn survivors. The process requires the collaboration of physiotherapists, occupational therapists, sports physiologists, nurses, and doctors from different fields [18]. Also, burn patient rehabilitation includes the management of positioning and orthosis, scar treatment, exercise prescription, education, and the management of symptoms that hinder function [19]. Rehabilitation difficulties include disparities in access to care, treatment techniques, and results in health care for different racial and ethnic groups at all levels of care [20]. However, according to a study, most questioned clinicians used exercise to rehabilitate patients after burn injuries, indicating high acceptance of various rehabilitation programs [21]. Hence, tele-rehabilitation refers to various approaches frequently made available through technology [22].

Role of Belgium Outcome Burn Injury Score System in Burns Patients

Aim of this case report is to predict the outcome of patients presenting with severe burns is crucial in guiding clinical judgment. Advancements in burn management over the years have significantly decreased burn mortality. There are various scoring systems that are formularized in predicting mortality in burns. In this article we would like to describe our pilot study in using Belgium outcome of burn injury scoring system (Table 1) in predicting mortality in burns patients.

Vital indicators in predicting burn mortality: A comparison of shock indices and burn shock indices.

In many studies, shock indices have proven to be good tools for predicting mortality. In the present study, burn shock index (BSI), percentage of total body surface area burned (TBSA%) multiplied by shock index; burn modified shock index (BMSI), TBSA% multiplied by modified shock index; burn age shock index (BASI), TBSA% multiplied by age shock index; burn rivers shock index (BrSI), TBSA% multiplied by rivers shock index; burn rivers shock index multiplied by Glasgow Coma Scale score (BrSIG) were examined in burn patients. We defined these burn shock indices for the first time. This study aimed to evaluate the effectiveness of shock indices and burn shock indices in predicting mortality in burn patients. This study examines retrospectively of burn patients admitted to the emergency department of Dicle University Hospital between January 2010 and December 2022. The patients' vital signs were obtained at the time of presentation to the emergency department, and shock indices were calculated. The effectiveness of shock indices in predicting mortality was compared. A total of 2445 patients were included in the study. Of the patients, 1793 were pediatric, and 652 were adults. BSI (AUC: 0.872, 95% confidence interval (CI): 0.812-0.931, p < 0.001) had the highest area under the curve (AUC) value in predicting mortality in children. The optimal cut-off value for BSI in children was 21.79 and its was sensitivity 83.05%, specificity 79.64%, positive predictive value (PPV) 12.19%, negative predictive value (NPV) 99.28%. In adults, BASI had the highest value of AUC (AUC: 0.936, 95% CI: 0.887-0.984, p < 0.001). The optimal cut-off value for BASI in adults was 62.5 and its sensitivity was 86.49%, specificity was 91.71%, PPV was 38.55%, and NPV was 99.12%. Shock indices are easy to calculate and effective in predicting mortality in burn patients admitted to the emergency department. Among the shock indices in the study, BSI was the best in predicting mortality in children, and BASI was the best in adults.

Sphingomonas Paucimobilis Bacteremia in a Patient with Major Burns Injury: A Case Report

Background:: Sphingomonas paucimobilis is an emerging opportunistic pathogen associated with hospital and community-acquired infections. Infection is the most common cause of morbidity and mortality in burn patients. Case Presentation:: We present a case of a 29-year-old lady who sustained severe burn injuries after a gas explosion at home. She was admitted to the United Arab Emirates (UAE) National Burns Unit and required several episodes of surgical debridement. She developed S. paucimobilis bloodstream infection whilst being treated with Piperacillin-tazobactam. She was subsequently treated with Meropenem for a total of 7 days after removing the source of infection, an infected central line. The S. paucimobilis isolate showed intermediate resistance to Piperacillin-tazobactam. Conclusion:: Numerous case reports indicate high morbidity in patients with life-threatening S. paucimobilis infections, immunocompromised patients, and patients with underlying medical comorbidity; however, this is the first reported case from the UAE.

Epidemiological and bacteriological profile of sepsis in burns patients: A report from tertiary care hospital, India

Background: Burns are one of the most prevalent and mortifying forms of trauma. Patients burn with significant thermal injury require immediate intensive care unit (ICU) care to minimize morbidity and mortality. Burns patients are generally more predisposed to sepsis because of two main reasons, i.e., burn wound infection and catheter-related bloodstream infection (CRBSI). Due to extensive skin barrier disruption and an alteration in the cellular and humoral immune responses burn wounds has a much higher incidence of sepsis as compared to other forms of trauma. Aims and Objectives: The present study was undertaken to study the bacteriological profile and sources of sepsis in burns patients and their antimicrobial susceptibility pattern. Materials and Methods: It is a prospective observational study conducted in the Department of Burns, Plastic and Maxillofacial Surgery, ICU and Department of Microbiology of a tertiary care hospital, Uttar Pradesh, India, between January 2020 and June 2022. Adult patients with 30–70% of total body surface area burns with central venous catheter (CVC) inserted during ICU admission were enrolled in the study. The presence of clinical sepsis in the burn patients was evaluated using the American Burn Association Sepsis criteria. For all patients with suspected clinical sepsis, paired blood cultures were collected simultaneously; one from the CVC and another from a peripheral site and were sent for bacteriological culture. Blood culture samples were processed as per standard procedures. CRBSI was defined if the same organism was isolated in paired blood cultures. Burn wound biopsy was sent for quantitative culture and 105 organisms/g of tissue were considered significant. Results: In the present study, the overall incidence of clinical sepsis was 28.4% (39/137), out of which 48.7% of cases were found to be due to CRBSI and the most common organism involved was Klebsiella spp. (42.1%), 33.3% of cases were due to burn wound sepsis and the most common organism involved was Pseudomonas spp. (61.5%); and 18.0% of cases were those in which no known source could be found. Possible explanations for these cases could be sepsis without bacteremia due to endotoxins and Gram-negative endotoxemia. Conclusion: To find out microorganisms causing burn wound infection by culture and provide suitable antibiotics according to their antibiotic sensitivity patterns helping us in managing these infection and decreasing overall morbidity and mortality in burn patients.

Risk Factors and Pathogens of Wound Infection in Burn Inpatients from East China.

Infection is the predominant contributor to morbidity and mortality in burn patients, and burn wound infection (BWI) is the most common reason. The objective of this research was to analyze the incidence, factors and progression of BWI, in terms of events and bacteria. Clinical variables of all qualified patients admitted to burn wards were analyzed retrospectively in 2021 at a tertiary hospital in eastern China through univariate analysis and multivariate logistic regression. The Kaplan-Meier method was also used for plotting survival curves. Isolates and resistance data were evaluated to demonstrate the evolution of targeted antibiotics of strains from BWI. A total of 580 (median age, 39.5 years (23-56 years); 372/580 (64.14%) male) patients were evaluated, 348 (60.0%) of whom experienced BWI. A variety of factors are associated with BWI. Multivariate logistic regression analysis showed that depth and area of burn and duration from burn to first hospitalization are independent risk factors for BWI. For BWI onset in these patients, 47.24% (274/580) occurred in the first week. The most frequently isolated causative organism was Staphylococcus aureus (15.7%) in patients with BWI. The duration of transition from Gram-positive strains (median 3 days, (2-7 days)) to Gram-negative (median 10 days, (4-17 days)) ones isolated from burn wound shrunk. Hospital length of stay was considered as a protective factor for BWI. The precise assessment of factors affecting BWI in burn patients enhances prompt and suitable management. Swab cultures for surveillance could be utilized to monitor the microbiological status of burn patients.

Relationship between body mass index and mortality of burns patients: A systematic review and meta-analysis.

This systematic review and meta-analysis aimed to evaluate the relationship between body mass index (BMI) and mortality of burn patients. A comprehensive, systematic search was conducted in different international electronic databases, such as Scopus, PubMed, Web of Science and Persian electronic databases such as Iranmedex, and Scientific Information Database (SID) using keywords extracted from Medical Subject Headings such as "Body mass index", "Burns" and "Mortality" from the earliest to the April 1, 2023. The quality of the studies included in this systematic review was evaluated using the appraisal tool for cross-sectional studies (AXIS tool). Finally, six articles were included in this systematic review and meta-analysis. A total of 16 154 burn patients participated in six studies. Their mean age was 46.32 (SD = 1.99). Of the participants, 71.7% were males. The mean length of hospitalization was 18.80 (SD = 8.08) days, and the average TBSA in burn patients was 38.32 (SD = 2.79) %. Also, the average BMI in burn patients was 27.10 (SD = 1.75). Results found mortality in patients with abnormal BMI (overweight to morbidity BMI) was 0.19 more than normal BMI (ES: 1.19, 95%CI: 0.76-1.87, Z = 0.75, I2 : 71.8%, p = 0.45). Results of linear dose-response showed each 5 kg/m2 increase in BMI was associated with a 5% increase in mortality that was marginally significant (ES: 1.05, 95%CI: 1.00-1.11, Z = 1.99, I2 : 22.2%, p = 0.047). There was a non-linear relationship between levels of BMI and mortality (Prob > χ2 = 0.02). There was an increase in mortality from percentile 10 to 50, although it was not significant (Correlational coefficient: 0.01, p = 0.85). Also, there was an increase in mortality rate from percentile 50 to 90 that was statistically significant (correlational coefficient: 0.06, p = 0.047). Finally, the results of the study indicated BMI can increase the chance of mortality by 0.19, although it was not significant. As a result, more studies are needed to better judge the relationship between BMI and mortality in burn victims.

Evaluation of Blood Lactate Concentrations as a Marker for Resuscitation and Prognosis in Patients with Major Burns

Background Severe burns require appropriate fluid management in the acute phase. A massive volume of intravenous fluid is usually required to ensure adequate end-organ perfusion. Lactate is a product of anaerobic metabolism. A high level of lactate in tissue is direct indication of tissue hypoxia. The correlation between serum lactate and clinical outcome has been well accepted in hemorrhagic and septic shock. However, studies on its use in predicting mortality and morbidity of major burn patients in particular is sparse. Early prediction of outcome in patients with major burn is very likely to aid suitable modification of management strategies. Objective To assess the role of serum lactate measurement as the predictor burn patient's outcome (survivors and non-survivors). Patients and Methods 30 patients with major burn (more than 20% of TBSA) were included. This includes operated/ non-operated patients. Of the 30 patients, 20 were males and 10 were females. All adult burned patients admitted within the first 24h post burn were included in the study. Patients admitted after 24h from the thermal injury, or those who were discharged or died 48h after admission were excluded. Results Serial blood lactate measures were better as a prognostic tool than isolated measure. Reduction or normalization of lactate levels 24 hours after admission was significantly associated with a higher probability of survival. This study confirms the prognostic value of serum lactate for mortality in patients with major burns as serial blood lactate measurements predict mortality in these patients. Conclusion Although many studies reiterate the importance of blood lactate and lactate clearance in predicting mortality in burn patients, the role of these markers in therapy titration is ambiguous. Overzealous fluid resuscitation can cause fluid overload and acute respiratory distress syndrome. little regional data are available to establish the importance of blood lactate. We have demonstrated the association of blood lactate in the first 36 hours of the burn injury with mortality. Further large multicenter prospective studies are required.