Risk factors of early myocardial injury and the impact of early myocardial injury on prognosis of patients with extensive burns

Chen Nuo; Xi Maomao; Ruan Qiongfang; Chu Zhigang; Zhang Wei; Zhang Jinli; Xie Weiguo

doi:10.3760/cma.j.cn501225-20230308-00074

Volume 39 Issue 5

May 2023

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Article Navigation > CHINESE JOURNAL OF BURNS AND WOUNDS > 2023 > 39(5): 417-423

Ru Tianfeng, Li Feihong, Xie Weiguo, et al. A prospective randomized controlled study of the effects of balance training combined with routine training on patients with lower limb motor and balance dysfunction after severe burns[J]. Chin j Burns, 2021, 37(4): 312-318. DOI: 10.3760/cma.j.cn501120-20201018-00441

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Chen N,Xi MM,Ruan QF,et al.Risk factors of early myocardial injury and the impact of early myocardial injury on prognosis of patients with extensive burns[J].Chin J Burns Wounds,2023,39(5):417-423.DOI: 10.3760/cma.j.cn501225-20230308-00074.

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Risk factors of early myocardial injury and the impact of early myocardial injury on prognosis of patients with extensive burns

doi: 10.3760/cma.j.cn501225-20230308-00074

1.
Institute of Burns, Tongren Hospital of Wuhan UniversityWuhan Third Hospital, Wuhan 430060, China
2.
The Second School of Clinical Medicine of Wuhan University, Wuhan 430060, China

Funds:

General Program of National Natural Science Foundation of China 81772097

Clinical Medical Research Program of Wuhan WG19B02

Shanghai Wang Zhengguo Foundation for Traumatic Medicine Growth Factor Rejuvenation Plan SZYZ-TR-10

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Corresponding author: Xie Weiguo, Email: wgxie@hotmail.com
Received Date: 2023-03-08

Abstract

Abstract

Objective To analyze the risk factors of early myocardial injury and the impact of early myocardial injury on prognosis of patients with extensive burns. Methods A retrospective case series study was conducted. From January 2018 to August 2022, 361 patients with extensive burns who met the inclusion criteria were admitted to Tongren Hospital of Wuhan University & Wuhan Third Hospital, including 231 males and 130 females, aged 50 (36, 58) years, with total burn area of 45% (35%, 60%) total body surface area. According to the highest level of creatine kinase isoenzyme-MB (CK-MB) within 72 h post injury, the patients were divided into early myocardial injury group (CK-MB≥75 U/L, 182 patients) and non-early myocardial injury group (CK-MB<75 U/L, 179 patients). The following data of patients in the 2 groups were collected and analyzed, including gender, age, total burn area, admission time post injury, combination with shock on admission, combination with inhalation injury on admission; the main blood test indexes such as myocardial enzyme spectrum, blood routine, liver and kidney function, and electrolytes within 72 h post injury; and treatment outcomes and fatality rate. Data were statistically analyzed with chi-square test, independent sample t test, or Mann-Whitney U test. The multivariate logistic regression analysis was conducted to screen the independent risk factors for early myocardial injury and for death in patients with extensive burns. Results There were statistically significant differences in gender, combination with shock on admission, total burn area, and admission time post injury of patients between the two groups (with χ ² values of 6.40 and 6.10, Z values of 5.41 and 3.03, respectively, P<0.05). There were no statistically significant differences in age, combination with inhalation injury on admission of patients between the two groups ( P>0.05). The CK-MB, creatine kinase, lactate dehydrogenase, α-hydroxybutyrate dehydrogenase, white blood cell count, neutrophil-to-lymphocyte ratio (NLR), alanine aminotransferase (ALT), aspartate aminotransferase, potassium, and hemoglobin within 72 h post injury were significantly higher than those in non-early myocardial injury group (with Z values of 15.40, 6.26, 7.59, 7.02, 2.64, 4.53, 4.07, 6.32, and 4.12, t=2.34, respectively, P<0.05), while the level of calcium was significantly lower than that in non-early myocardial injury group ( Z=2.72, P<0.05). There were no statistically significant differences in other blood test indexes of patients between the two groups ( P>0.05). The total burn area, admission time post injury, NLR and ALT within 72 h post injury were the independent risk factors for early myocardial injury in patients with extensive burns (with odds ratios of 1.03, 1.07, 1.04, and 1.02, 95% confidence intervals of 1.02-1.05, 1.00-1.11, 1.02-1.07, and 1.00-1.03, respectively, P<0.05). The fatality rate of patients in early myocardial injury group was 8.8% (16/182), which was significantly higher than 2.8% (5/179) in non-early myocardial injury group ( χ ²=5.93, P<0.05). Early myocardial injury, age, combination with shock on admission, and combination with inhalation injury on admission were the independent risk factors for death in patients with extensive burns (with odds ratios of 3.60, 1.04, 6.53, and 3.14, 95% confidence intervals of 1.17-11.05, 1.01-1.07, 1.39-30.68, and 1.15-8.56, respectively, P<0.05). Conclusions The total burn area, admission time post injury, NLR and ALT within 72 h post injury were the independent risk factors for early myocardial injury in patients with extensive burns. Patients with extensive burns with early myocardial injury have a higher fatality rate, and early myocardial injury is an independent risk factor for the patients' death.
- Burns,
- Risk factors,
- Prognosis,
- Myocardial injury

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[1]	黄跃生.再论烧伤后“休克心”及其临床意义[J].中华烧伤杂志,2009,25(3):161-163.DOI: 10.3760/cma.j.issn.1009-2587.2009.03.001.
[2]	黄跃生.严重烧伤早期心肌损害机制及临床意义的再认识[J].中华烧伤杂志,2016,32(5):257-259.DOI: 10.3760/cma.j.issn.1009-2587.2016.05.001.
[3]	张灿,张均辉,张东霞,等.252例严重烧伤患者心肌损伤情况的回顾性研究[J].中华烧伤杂志,2016,32(5):260-265.DOI: 10.3760/cma.j.issn.1009-2587.2016.05.002.
[4]	罗高兴,彭毅志,庄颖,等.烧伤休克期有关补液公式的临床应用与评价[J].中华烧伤杂志,2008,24(4):248-250.DOI: 10.3760/cma.j.issn.1009-2587.2008.04.003.
[5]	PanchalA,CasadonteJ.Burn-induced myocardial depression in a pediatric patient leading to fulminant cardiogenic shock and multiorgan failure requiring extracorporeal life support[J].Clin Case Rep,2020,8(4):602-605.DOI: 10.1002/ccr3.2667.
[6]	TapkingC,PoppD,HerndonDN,et al.Cardiac dysfunction in severely burned patients: current understanding of etiology, pathophysiology, and treatment[J].Shock,2020,53(6):669-678.DOI: 10.1097/SHK.0000000000001465.
[7]	张兵钱,黄跃生,张家平,等.依那普利拉对严重烫伤大鼠早期心肌损害的防治作用[J].中华烧伤杂志,2007,23(5):335-338.DOI: 10.3760/cma.j.issn.1009-2587.2007.05.005.
[8]	DeJesusJE,WenJJ,RadhakrishnanR.Cytokine pathways in cardiac dysfunction following burn injury and changes in genome expression[J].J Pers Med,2022,12(11):1876.DOI: 10.3390/jpm12111876.
[9]	LiuCP,LiuYJ,ChenHQ,et al.Myocardial injury: where inflammation and autophagy meet[J/OL].Burns Trauma,2023,11:tkac062[2023-03-08].https://pubmed.ncbi.nlm.nih.gov/36873283/.DOI: 10.1093/burnst/tkac062.
[10]	WhiteJ,ThomasJ,MaassDL,et al.Cardiac effects of burn injury complicated by aspiration pneumonia-induced sepsis[J].Am J Physiol Heart Circ Physiol,2003,285(1):H47-58.DOI: 10.1152/ajpheart.00833.2002.
[11]	Krbcová MoudráV,ZajíčekR,BakalářB,et al.Burn-induced cardiac dysfunction: a brief review and long-term consequences for cardiologists in clinical practice[J].Heart Lung Circ,2021,30(12):1829-1833.DOI: 10.1016/j.hlc.2021.06.444.
[12]	樊兴成年大面积烧伤患者预后影响因素的病例对照研究长春吉林大学 2022 樊兴.成年大面积烧伤患者预后影响因素的病例对照研究[D].长春:吉林大学, 2022.
[13]	BobbGA,FairchildEJ.Neutrophil-to-lymphocyte ratio as indicator of ozone exposure[J].Toxicol Appl Pharmacol,1967,11(3):558-564.DOI: 10.1016/0041-008x(67)90056-7.
[14]	KimHY, KongYG, ParkJH, et al. Acute kidney injury after burn surgery: preoperative neutrophil/lymphocyte ratio as a predictive factor[J]. Acta Anaesthesiol Scand,2019,63(2):240-247.DOI: 10.1111/aas.13255.
[15]	FussJ,VoloboyevaA,PoliovyjV.Prognostic value of using neutrophil-lymphocyte ratio in patients with burn injury for the diagnosis of sepsis and bacteraemia[J].Pol Przegl Chir,2018,90(5):13-16.DOI: 10.5604/01.3001.0012.0971.
[16]	QiuL, JinX, WangJJ, et al. Plasma neutrophil-to-lymphocyte ratio on the third day postburn is associated with 90-day mortality among patients with burns over 30% of total body surface area in two Chinese burns centers[J]. J Inflamm Res,2021,14:519-526.DOI: 10.2147/JIR.S294543.
[17]	HuLY,WangBL,HongYG,et al.Admission neutrophil-lymphocyte ratio (NLR) predicts survival in patients with extensive burns[J].Burns,2021,47(3):594-600.DOI: 10.1016/j.burns.2020.07.028.
[18]	汤旭东中性粒细胞与淋巴细胞的比值对严重烧伤患者预后的判断价值合肥安徽医科大学 2020 汤旭东.中性粒细胞与淋巴细胞的比值对严重烧伤患者预后的判断价值[D].合肥:安徽医科大学,2020.
[19]	LiuL,ZhengYQ,CaiLP,et al.Neutrophil-to-lymphocyte ratio, a critical predictor for assessment of disease severity in patients with COVID-19[J].Int J Lab Hematol,2021,43(2):329-335.DOI: 10.1111/ijlh.13374.
[20]	ChenZY,RaghavK,LieuCH,et al.Cytokine profile and prognostic significance of high neutrophil-lymphocyte ratio in colorectal cancer[J].Br J Cancer,2015,112(6):1088-1097.DOI: 10.1038/bjc.2015.61.
[21]	AkujuruEE, ApriokuJS, OkerengwoAA. Circulatory levels of pro-inflammatory cytokines (IL-6 and IL-1β) and neutrophil-lymphocyte ratio (NLR) in diabetic patients in Nigerian population[J]. Comp Clin Pathol,2020,29(2):539-545.DOI: 10.1007/s00580-019-03086-8.
[22]	KokB,LesterELW,LeeWM,et al.Acute liver failure from tumor necrosis factor-α antagonists: report of four cases and literature review[J].Dig Dis Sci,2018,63(6):1654-1666.DOI: 10.1007/s10620-018-5023-6.
[23]	IdrovoJP,BoeDM,KaahuiS,et al.Hepatic inflammation after burn injury is associated with necroptotic cell death signaling[J].J Trauma Acute Care Surg,2020,89(4):768-774.DOI: 10.1097/TA.0000000000002865.
[24]	LiJ,ZhaoZ,JiangH,et al.Predictive value of elevated alanine aminotransferase for in-hospital mortality in patients with acute myocardial infarction[J].BMC Cardiovasc Disord,2021,21(1):82.DOI: 10.1186/s12872-021-01903-z.
[25]	El HadiH,Di VincenzoA,VettorR,et al.Relationship between heart disease and liver disease: a two-way street[J].Cells,2020,9(3):567.DOI: 10.3390/cells9030567.
[26]	BekkelundSI.Serum alanine aminotransferase activity and risk factors for cardiovascular disease in a Caucasian population: the Tromsø study[J].BMC Cardiovasc Disord,2021,21(1):29.DOI: 10.1186/s12872-020-01826-1.

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Risk factors of early myocardial injury and the impact of early myocardial injury on prognosis of patients with extensive burns

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Risk factors of early myocardial injury and the impact of early myocardial injury on prognosis of patients with extensive burns

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