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Volume 39 Issue 6
Jun.  2023
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Article Navigation >  CHINESE JOURNAL OF BURNS AND WOUNDS  > 2023  >  39(6): 558-564
Pan XL,Zhu ZK,Shen T,et al.Epidemiological characteristics and risk factors of sepsis development and death in patients with extremely severe burns[J].Chin J Burns Wounds,2023,39(6):558-564.DOI: 10.3760/cma.j.cn501225-20220806-00336.
Citation: Pan XL,Zhu ZK,Shen T,et al.Epidemiological characteristics and risk factors of sepsis development and death in patients with extremely severe burns[J].Chin J Burns Wounds,2023,39(6):558-564.DOI: 10.3760/cma.j.cn501225-20220806-00336.
shu

Epidemiological characteristics and risk factors of sepsis development and death in patients with extremely severe burns

doi: 10.3760/cma.j.cn501225-20220806-00336
  • 1.

    Department of Burn and Wound Repair, the Second Affiliated Hospital of Zhejiang University School of Medicine, Key Laboratory of the Diagnosis and Treatment of Severe Trauma and Burn of Zhejiang Province, Hangzhou 310009, China

  • 2.

    Rehabilitation Department of Traditional Chinese Medicine, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, China

Funds:

The Joint Fund Project of National Natural Science Foundation of China U21A20370

Key Research and Development Project of Zhejiang Province of China 2019C03083

More Information
  • Corresponding author: Han Chunmao, Email: zrssk@zju.edu.cn
  • Received Date: 2022-08-06
    Abstract
  •   Objective   To explore the epidemiological characteristics and risk factors of sepsis development and death in patients with extremely severe burns.   Methods   A retrospective case series study was conducted. From January 2017 to December 2021, 135 patients with extremely severe burns who met the inclusion criteria were admitted to the Department of Burn and Wound Repair of the Second Affiliated Hospital of Zhejiang University School of Medicine, including 100 males and 35 females, aged 18-84 years. The incidence and diagnosis time of sepsis, the rate of positive microbial culture of blood samples (hereinafter referred to as positive blood culture), and the mortality rate of all patients, as well as the incidence of sepsis and the pathogen of infection in patients with positive blood culture were recorded (statistically analyzed with chi-square test or Fisher's exact probability test). According to the occurrence of sepsis, all patients were divided into sepsis group (58 cases) and non-sepsis group (77 cases), and the gender, age, body mass index, history of hypertension, history of diabetes, combination of inhalation injury, burn site, burn type, total burn area, and combined injury of patients were compared between the two groups. According to the outcome, all patients were divided into death group (37 cases) and survival group (98 cases), and the aforementioned data grouped according to sepsis as well as the stability of shock period and the combination of sepsis of patients were compared between the two groups. The aforementioned data between two groups were statistically analyzed with univariate analysis of independent sample t test, Wilcoxon rank-sum test, Mann-Whitney U test, chi-square test, or Fisher's exact probability test. Factors with P<0.1 were selected for multivariate logistic regression analysis to screen independent risk factors of sepsis and death in patients with extremely severe burns.   Results   Among all patients, the incidence of sepsis was 42.96% (58/135), the diagnosis time of sepsis was 14 (7, 24) d after injury, the positive blood culture rate was 62.22% (84/135), and the mortality rate was 27.41% (37/135). The incidence of sepsis of patients with positive blood culture was 69.05% (58/84). The top 5 pathogenic bacteria in the detection rate of septic patients with positive blood culture were Acinetobacter baumannii, Klebsiella pneumoniae, Pseudomonas aeruginosa, Staphylococcus aureus, and Enterobacter cloacae, ranking from high to low, and the proportion of Acinetobacter baumannii infected was significantly higher than that of non-septic patients with positive blood culture ( χ 2=7.49, P<0.05). Compared with those in non-sepsis group, the proportion of combination of inhalation injury, the proportion of perineal burns, and the total burn area of patients in sepsis group increased significantly (with χ 2 values of 11.08 and 17.47, respectively, Z=5.68, P<0.05), while the other indicators did not change significantly ( P>0.05). Multivariate logistic regression analysis showed that combination of inhalation injury, total burn area ≥80% total body surface area (TBSA), and perineal burns were independent risk factors for patients with extremely severe burns developing sepsis (with odds ratios of 3.15, 7.24, and 3.24, respectively, with 95% confidence intervals of 1.07 to 9.29, 1.79 to 29.34, and 1.21 to 8.68, respectively, P<0.05). Compared with those in survival group, the proportion of combination of inhalation injury, the proportion of perineal burns, and the proportion of combination of sepsis (with χ 2 values of 6.55, 11.64, and 22.26, respectively, Pvalues all <0.05), total burn area ( Z=4.25, P<0.05), and proportion of instability of shock period ( P<0.05) of patients in death group all increased significantly, while the other indicators did not change significantly ( P>0.05). Multivariate logistic regression analysis showed that the instability of shock period and combination of sepsis were independent risk factors for death of patients with extremely severe burns (with odds ratios of 4.87 and 3.45, respectively, with 95% confidence intervals of 1.21 to 19.57 and 1.28 to 9.33, respectively, P<0.05).   Conclusions   Patients with extremely severe burns have a high incidence of sepsis and a high mortality rate. The peak period of sepsis onset is 2 weeks after injury, with Acinetobacter baumannii as the most prominent infectious pathogen. Combination of inhalation injury, total burn area ≥80% TBSA, and perineal burns are independent risk factors for extremely severe burn patients complicated with sepsis, and combination of sepsis and instability of shock period are independent risk factors for death of patients with extremely severe burns.

     

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    • References(35)
  • [1]
    罗高兴.烧伤后脏器并发症的发生与防治[J].中华烧伤杂志,2019,35(8):565-567.DOI: 10.3760/cma.j.issn.1009-2587.2019.08.002.
    [2]
    TianH,WangL,XieW,et al.Epidemiologic and clinical characteristics of severe burn patients: results of a retrospective multicenter study in China, 2011-2015[J/OL].Burns Trauma,2018,6:14[2022-08-06].https://pubmed.ncbi.nlm.nih.gov/29850643/.DOI: 10.1186/s41038-018-0118-z.
    [3]
    EvansL,RhodesA,AlhazzaniW,et al.Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021[J].Intensive Care Med,2021,47(11):1181-1247.DOI: 10.1007/s00134-021-06506-y.
    [4]
    ZhangP,ZouB,LiouYC,et al.The pathogenesis and diagnosis of sepsis post burn injury[J/OL].Burns Trauma,2021,9:tkaa047[2022-08-06].https://pubmed.ncbi.nlm.nih.gov/33654698/.DOI: 10.1093/burnst/tkaa047.
    [5]
    ManningJ.Sepsis in the burn patient[J].Crit Care Nurs Clin North Am,2018,30(3):423-430.DOI: 10.1016/j.cnc.2018.05.010.
    [6]
    GreenhalghDG.Sepsis in the burn patient: a different problem than sepsis in the general population[J/OL].Burns Trauma,2017,5:23[2022-08-06].https://pubmed.ncbi.nlm.nih.gov/28795054/.DOI: 10.1186/s41038-017-0089-5.
    [7]
    SingerM,DeutschmanCS,SeymourCW,et al.The third international consensus definitions for sepsis and septic shock (sepsis-3)[J].JAMA,2016,315(8):801-810.DOI: 10.1001/jama.2016.0287.
    [8]
    DastagirK,KrezdornN,BingoelAS,et al.Application of critical care scores in severely burned patients[J].J Burn Care Res,2021,42(6):1176-1180.DOI: 10.1093/jbcr/irab030.
    [9]
    YoonJ,KymD,HurJ,et al.Comparative usefulness of sepsis-3, burn sepsis, and conventional sepsis criteria in patients with major burns[J].Crit Care Med,2018,46(7):e656-e662.DOI: 10.1097/CCM.0000000000003144.
    [10]
    ISBI Practice Guidelines Committee,SubcommitteeAdvisory,SubcommitteeSteering.ISBI practice guidelines for burn care, part 2[J].Burns,2018,44(7):1617-1706.DOI: 10.1016/j.burns.2018.09.012.
    [11]
    梁琦强,韩春茂,黄曼.烧伤脓毒症诊断:脓毒症3.0适用吗[J].中华急诊医学杂志,2020,29(12):1509-1514.DOI: 10.3760/cma.j.issn.1671-0282.2020.12.002.
    [12]
    姚咏明,张卉,童亚林.深化对烧伤脓毒症诊断体系与治疗策略的认识[J].中华烧伤杂志,2021,37(5):404-409.DOI: 10.3760/cma.j.cn501120-20200703-00337.
    [13]
    GreenhalghDG,SaffleJR,4thHolmes JH,et al.American Burn Association consensus conference to define sepsis and infection in burns[J].J Burn Care Res,2007,28(6):776-790.DOI: 10.1097/BCR.0b013e3181599bc9.
    [14]
    LadhaniHA,YowlerCJ,ClaridgeJA.Burn wound colonization, infection, and sepsis[J].Surg Infect (Larchmt),2021,22(1):44-48.DOI: 10.1089/sur.2020.346.
    [15]
    PengY,ChenJ,YuanZ,et al.Diagnostic criteria and treatment protocol for post-burn sepsis[J].Crit Care,2013,17(1):406.DOI: 10.1186/cc11912.
    [16]
    中国医师协会烧伤医师分会《烧伤感染诊治指南》编辑委员会.烧伤感染的诊断标准与治疗指南(2012版)[J].中华烧伤杂志,2012,28(6):401-403.DOI: 10.3760/cma.j.issn.1009-2587.2012.06.001.
    [17]
    StanojcicM,VinaikR,JeschkeMG.Status and challenges of predicting and diagnosing sepsis in burn patients[J].Surg Infect (Larchmt),2018,19(2):168-175.DOI: 10.1089/sur.2017.288.
    [18]
    郑峰,王大明,刘宁,等.特重度烧伤脓毒症患者预后评价指标的分析[J].中华危重病急救医学,2017,29(4):327-331.DOI: 10.3760/cma.j.issn.2095-4352.2017.04.008.
    [19]
    王亚菲,赵永健,孙健.重度烧伤患者脓毒症发生的影响因素及预后分析[J].山东医药,2019,59(34):63-65.DOI: 10.3969/j.issn.1002-266X.2019.34.017.
    [20]
    徐风瑞,乔亮,韩伟,等.大面积烧伤并发脓毒症的独立危险因素[J].中华创伤杂志,2016,32(3):237-240.DOI: 10.3760/cma.j.issn.1001-8050.2016.03.010.
    [21]
    D'AbbondanzaJA,ShahrokhiS.Burn infection and burn sepsis[J].Surg Infect (Larchmt),2021,22(1):58-64.DOI: 10.1089/sur.2020.102.
    [22]
    钱芳,梁琦强,黄曼.使用oXiris®强化血液净化方案治疗重症烧伤患者脓毒症相关急性肾损伤:一项单中心研究[J].中华急诊医学杂志,2020,29(12):1572-1576.DOI: 10.3760/cma.j.issn.1671-0282.2020.12.012.
    [23]
    周瑜,梁琦强,须欣,等.一起槽罐车爆炸事件中15例特重烧创伤患者的救治情况[J].中华急诊医学杂志,2020,29(12):1566-1571.DOI: 10.3760/cma.j.issn.1671-0282.2020.12.011.
    [24]
    张寅,马珍珠,吴蓓雯,等.特重度烧伤患者血流感染风险早期预测模型的建立及其预测价值分析[J].中华烧伤杂志,2021,37(6):530-537.DOI: 10.3760/cma.j.cn501120-20210114-00021.
    [25]
    汤陈琪,李骏强,寿倍明,等.某次工业灾难中177例严重烧伤患者的血流感染分析[J].中华烧伤杂志,2018,34(6):431-432.DOI: 10.3760/cma.j.issn.1009-2587.2018.06.028.
    [26]
    高莹,李宝,高红红.烧伤脓毒症患者危险因素及脂蛋白相关磷酯酶过氧化脂质预测价值分析[J].中国急救医学,2019,39(3):221-225.DOI: 10.3969/j.issn.1002-1949.2019.03.005.
    [27]
    郑玉红,李华强,王付勇,等.重度烧伤后并发脓毒症的危险因素[J].中华医院感染学杂志,2020,30(23):3526-3529.DOI: 10.11816/cn.ni.2020-201489.
    [28]
    WinebergD,MooreR,KrugerD.Procalcitonin and bacterial sepsis in burn patients in South Africa[J].J Surg Res,2020,246:490-498.DOI: 10.1016/j.jss.2019.09.040.
    [29]
    SteinvallI,ElmasryM,FredriksonM,et al.Standardised mortality ratio based on the sum of age and percentage total body surface area burned is an adequate quality indicator in burn care: an exploratory review[J].Burns,2016,42(1):28-40.DOI: 10.1016/j.burns.2015.10.032.
    [30]
    CecconiM,EvansL,LevyM,et al.Sepsis and septic shock[J].Lancet,2018,392(10141):75-87.DOI: 10.1016/S0140-6736(18)30696-2.
    [31]
    贾赤宇,张泽鑫,李姝,等.烧伤脓毒症的免疫抑制与免疫疗法:理念、挑战与希望[J/CD].中华损伤与修复杂志:电子版,2022,17(5):379-389.DOI: 10.3877/cma.j.issn.1673-9450.2022.05.002.
    [32]
    LiW,WangM,ZhuB,et al.Prediction of median survival time in sepsis patients by the SOFA score combined with different predictors[J/OL].Burns Trauma,2020,8:tkz006[2022-08-06].https://pubmed.ncbi.nlm.nih.gov/32346543/.DOI: 10.1093/burnst/tkz006.
    [33]
    黄跃生.严重烧伤脏器损害综合防治的思考[J].中华烧伤杂志,2020,36(8):647-650.DOI: 10.3760/cma.j.cn501120-20200521-00278.
    [34]
    郇京宁,黄晓琴.控制大面积烧伤患者过度液体复苏预防并发症[J].中华烧伤与创面修复杂志,2022,38(1):13-20.DOI: 10.3760/cma.j.cn501120-20210813-00281.
    [35]
    朱峰,郑兴锋,伍国胜.对成人烧伤休克与复苏的再思考[J].中华医学杂志,2020,100(18):1372-1375.DOI: 10.3760/cma.j.cn112137-20191129-02601.
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