Survival Analysis and Mortality Predictors of Hospitalized Severe Burn Victims in a Malaysian Burns Intensive Care Unit

Overview

Journal Burns Trauma

Publisher Oxford University Press

Date 2019 Feb 2

PMID 30705904

Citations 20

Authors

Henry Tan Chor Lip

Jih Huei Tan

Mathew Thomas

Farrah-Hani Imran

Tuan Nur Azmah Tuan Mat

Affiliations

Soon will be listed here.

Abstract

Background: Prognostic measures to determine burn mortality are essential in evaluating the severity of individual burn victims. This is an important process of triaging patients with high risk of mortality that may be nursed in the acute care setting. Malaysian burn research is lacking with only one publication identified which describes the epidemiology of burn victims. Therefore, the objective of this study was to go one step further and identify the predictors of burn mortality from a Malaysian burns intensive care unit (BICU) which may be used to triage patients at higher risk of death.

Methods: This is a retrospective cohort study of all admissions to Hospital Sultan Ismail's BICU from January 2010 till October 2015. Admission criteria were in accordance with the American Burn Association guidelines, and risk factors of interest were recorded. Data was analyzed using simple logistic regression to determine significant predictors of mortality. Survival analysis with time to death event was performed using the Kaplan-Meier survival curve with log-rank test.

Results: Through the 6-year period, 393 patients were admitted with a male preponderance of 73.8%. The mean age and length of stay were 35.6 (±15.72) years and 15.3 (±18.91) days. There were 48 mortalities with an overall mortality rate of 12.2%. Significant risk factors identified on simple logistic regression were total body surface area (TBSA) > 20% ( < 0.001), inhalation injury ( < 0.001) and presence of early systemic inflammatory response syndrome (SIRS) ( < 0.001). Survival analysis using Kaplan-Meier survival curve showed similar results with TBSA > 20%, presence of SIRS, mechanical ventilation and inhalation injury which were associated with poorer survival ( < 0.001).

Conclusion: The predictors of mortality identified in a Malaysian BICU were TBSA > 20%, early SIRS, mechanical ventilation and inhalation injury which were associated with poorer survival outcome. The immunological response differs from individual patients and influenced by the severity of burn injury. Early SIRS on admission is an important predictor of death and may represent the severity of burn injury. Patients who required mechanical ventilation were associated with mortality and it is likely related to the severity of pulmonary insults sustained by individual patients. This data is important for outcome prognostication and mortality risk counselling in severely burned patients.

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References

Yeh F, Lin W, Shen H . Changes in circulating levels of an anti-inflammatory cytokine interleukin 10 in burned patients. Burns. 2000; 26(5):454-9. DOI: 10.1016/s0305-4179(99)00174-6. View

Yeh F, Shen H, Fang R . Deficient transforming growth factor beta and interleukin-10 responses contribute to the septic death of burned patients. Burns. 2002; 28(7):631-7. DOI: 10.1016/s0305-4179(02)00113-4. View

Grimble R . Inflammatory response in the elderly. Curr Opin Clin Nutr Metab Care. 2002; 6(1):21-9. DOI: 10.1097/00075197-200301000-00005. View

Chan K, Hairol O, Imtiaz H, Zailani M, Kumar S, Somasundaram S . A review of burns patients admitted to the Burns Unit of Hospital Universiti Kebangsaan Malaysia. Med J Malaysia. 2003; 57(4):418-25. View

Ueyama M, Maruyama I, Osame M, Sawada Y . Marked increase in plasma interleukin-6 in burn patients. J Lab Clin Med. 1992; 120(5):693-8. View

Song C, Chua A . Epidemiology of burn injuries in Singapore from 1997 to 2003. Burns. 2005; 31 Suppl 1:S18-26. DOI: 10.1016/j.burns.2004.10.005. View

Lionelli G, Pickus E, Beckum O, Decoursey R, Korentager R . A three decade analysis of factors affecting burn mortality in the elderly. Burns. 2005; 31(8):958-63. DOI: 10.1016/j.burns.2005.06.006. View

Steinvall I, Bak Z, Sjoberg F . Acute respiratory distress syndrome is as important as inhalation injury for the development of respiratory dysfunction in major burns. Burns. 2008; 34(4):441-51. DOI: 10.1016/j.burns.2007.10.007. View

Bloemsma G, Dokter J, Boxma H, Oen I . Mortality and causes of death in a burn centre. Burns. 2008; 34(8):1103-7. DOI: 10.1016/j.burns.2008.02.010. View

10.

Guo F, Chen X, Wang Y, Wang F, Chen X, Sun Y . Management of burns of over 80% of total body surface area: a comparative study. Burns. 2008; 35(2):210-4. DOI: 10.1016/j.burns.2008.05.021. View

11.

Ganesamoni S, Kate V, Sadasivan J . Epidemiology of hospitalized burn patients in a tertiary care hospital in South India. Burns. 2009; 36(3):422-9. DOI: 10.1016/j.burns.2009.06.212. View

12.

Pham T, Kramer C, Klein M . Risk factors for the development of pneumonia in older adults with burn injury. J Burn Care Res. 2010; 31(1):105-10. PMC: 3045669. DOI: 10.1097/BCR.0b013e3181cb8c5a. View

13.

Mann E, Baun M, Meininger J, Wade C . Comparison of mortality associated with sepsis in the burn, trauma, and general intensive care unit patient: a systematic review of the literature. Shock. 2011; 37(1):4-16. DOI: 10.1097/SHK.0b013e318237d6bf. View

14.

Patel B, Paratz J, Mallet A, Lipman J, Rudd M, Muller M . Characteristics of bloodstream infections in burn patients: An 11-year retrospective study. Burns. 2012; 38(5):685-90. DOI: 10.1016/j.burns.2011.12.018. View

15.

Kumar N, Kanchan T, Unnikrishnan B, Rekha T, Mithra P, Venugopal A . Clinico-epidemiological profile of burn patients admitted in a tertiary care hospital in coastal South India. J Burn Care Res. 2012; 33(5):660-7. DOI: 10.1097/BCR.0b013e31824795b7. View

16.

Mann-Salinas E, Baun M, Meininger J, Murray C, Aden J, Wolf S . Novel predictors of sepsis outperform the American Burn Association sepsis criteria in the burn intensive care unit patient. J Burn Care Res. 2012; 34(1):31-43. DOI: 10.1097/BCR.0b013e31826450b5. View

17.

Taylor S, Lawless M, Curri T, Sen S, Greenhalgh D, Palmieri T . Predicting mortality from burns: the need for age-group specific models. Burns. 2014; 40(6):1106-15. PMC: 4143432. DOI: 10.1016/j.burns.2014.03.010. View

18.

Goodhew F, Van Hooff M, Sparnon A, Roberts R, Baur J, Saccone E . Psychiatric outcomes amongst adult survivors of childhood burns. Burns. 2014; 40(6):1079-88. DOI: 10.1016/j.burns.2014.04.017. View

19.

Seo D, Kym D, Yim H, Yang H, Cho Y, Kim J . Epidemiological trends and risk factors in major burns patients in South Korea: a 10-year experience. Burns. 2014; 41(1):181-7. DOI: 10.1016/j.burns.2014.05.004. View

20.

You K, Yang H, Kym D, Yoon J, HaejunYim , Cho Y . Inhalation injury in burn patients: establishing the link between diagnosis and prognosis. Burns. 2014; 40(8):1470-5. DOI: 10.1016/j.burns.2014.09.015. View