Volume 40 Issue 3
Mar.  2024
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Ma QM,Tang WB,Li XJ,et al.Multicenter retrospect analysis of early clinical features and analysis of risk factors on prognosis of elderly patients with severe burns[J].Chin J Burns Wounds,2024,40(3):249-257.DOI: 10.3760/cma.j.cn501225-20230808-00042.
Citation: Ma QM,Tang WB,Li XJ,et al.Multicenter retrospect analysis of early clinical features and analysis of risk factors on prognosis of elderly patients with severe burns[J].Chin J Burns Wounds,2024,40(3):249-257.DOI: 10.3760/cma.j.cn501225-20230808-00042.

Multicenter retrospect analysis of early clinical features and analysis of risk factors on prognosis of elderly patients with severe burns

doi: 10.3760/cma.j.cn501225-20230808-00042
Funds:

National Key Research and Development Program "Stem Cell and Transformation Research" Key Special Project 2019YFA0110601

Shanghai Pudong New Area Summit (Emergency Medicine and Critical Care) Construction Project PWYgf2021-03

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  •   Objective   To investigate the early clinical characteristics of elderly patients with severe burns and the risk factors on prognosis.   Methods   This study was a retrospective case series study. Clinical data of 124 elderly patients with severe burns who met the inclusion criteria and were admitted to the 12 hospitals from January 2015 to December 2020 were collected, including 4 patients from the Fourth People's Hospital of Dalian, 5 patients from Fujian Medical University Union Hospital, 22 patients from Guangzhou Red Cross Hospital of Jinan University, 5 patients from Heilongjiang Provincial Hospital, 27 patients from the First Affiliated Hospital of Naval Medical University, 9 patients from the First Affiliated Hospital of Nanchang University, 10 patients from Affiliated Hospital of Nantong University, 9 patients from Tongren Hospital of Wuhan University & Wuhan Third Hospital, 12 patients from the 924 th Hospital of PLA, 6 patients from Zhangjiagang First People's Hospital, 4 patients from Taizhou Hospital of Zhejiang Province, and 11 patients from Zhengzhou First People's Hospital. The patients' overall clinical characteristics, such as gender, age, body mass index, total burn area, full-thickness burn area, inhalation injury, causative factors, whether combined with underlying medical diseases, and admission time after injury were recorded. According to the survival outcome within 28 days after injury, the patients were divided into survival group (89 cases) and death group (35 cases). The following data of patients were compared between the two groups, including the basic data and injuries (the same as the overall clinical characteristics ahead); the coagulation indexes within the first 24 hours of injury such as prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time, D-dimer, fibrinogen degradation product (FDP), international normalized ratio (INR), and fibrinogen; the blood routine indexes within the first 24 hours of injury such as white blood cell count, platelet count, neutrophil-to-lymphocyte ratio, monocyte count, red blood cell count, hemoglobin, and hematocrit; the organ function indexes within the first 24 hours of injury such as direct bilirubin, total bilirubin, urea, serum creatinine, aspartate aminotransferase, alanine aminotransferase, total protein, albumin, globulin, blood glucose, triglyceride, total cholesterol, alkaline phosphatase, creatine kinase, electrolyte indexes (potassium, sodium, chlorine, calcium, magnesium, and phosphorus in blood), uric acid, myoglobin, and brain natriuretic peptide; the infection and blood gas indexes within the first 24 hours of injury such as procalcitonin, C-reactive protein, pH value, oxygenation index, base excess, and lactate; treatment such as whether conducted with mechanical ventilation, whether conducted with continuous renal replacement therapy, whether conducted with anticoagulation therapy, whether applied with vasoactive drugs, and fluid resuscitation. The analysis was conducted to screen the independent risk factors for the mortality within 28 days after injury in elderly patients with severe burns.   Results   Among 124 patients, there were 82 males and 42 females, aged 60-97 years, with body mass index of 23.44 (21.09, 25.95) kg/m 2, total burn area of 54.00% (42.00%, 75.00%) total body surface area (TBSA), and full-thickness burn area of 25.00% (10.00%, 40.00%) TBSA. The patients were mainly combined with moderate to severe inhalation injury and caused by flame burns. There were 43 cases with underlying medical diseases. The majority of patients were admitted to the hospital within 8 hours after injury. There were statistically significant differences between patients in the 2 groups in terms of age, total burn area, full-thickness burn area, and inhalation injury, and PT, APTT, D-dimer, FDP, INR, white blood cell count, platelet count, urea, serum creatinine, blood glucose, blood sodium, uric acid, myoglobin, and urine volume within the first 24 hours of injury (with Z values of 2.37, 5.49, 5.26, 5.97, 2.18, 1.95, 2.68, 2.68, 2.51, 2.82, 2.14, 3.40, 5.31, 3.41, 2.35, 3.81, 2.16, and -3.82, respectively, P<0.05); there were statistically significant differences between two groups of patients in whether conducted with mechanical ventilation and whether applied with vasoactive drugs (with χ 2 values of 9.44 and 28.50, respectively, P<0.05). Age, total burn area, full-thickness burn area, serum creatinine within the first 24 hours of injury, and APTT within the first 24 hours of injury were the independent risk factors for the mortality within 28 days after injury in elderly patients with severe burns (with odds ratios of 1.17, 1.10, 1.10, 1.09, and 1.27, 95% confidence intervals of 1.03-1.40, 1.04-1.21, 1.05-1.19, 1.05-1.17, and 1.07-1.69, respectively, P<0.05).   Conclusions   The elderly patients with severe burns had the injuries mainly from flame burns, often accompanied by moderate to severe inhalation injury and enhanced inflammatory response, elevated blood glucose levels, activated fibrinolysis, and impaired organ function in the early stage, which are associated with their prognosis. Age, total burn area, full-thickness burn area, and serum creatinine and APTT within the first 24 hours of injury are the independent risk factors for death within 28 days after injury in this population.

     

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  • [1]
    GBD 2019 Diseases and Injuries Collaborators. Global burden of 369 diseases and injuries in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019[J]. Lancet, 2020,396(10258):1204-1222. DOI: 10.1016/S0140-6736(20)30925-9.
    [2]
    KeckM, LumentaDB, AndelH, et al. Burn treatment in the elderly[J]. Burns, 2009,35(8):1071-1079. DOI: 10.1016/j.burns.2009.03.004.
    [3]
    JeschkeMG, PeckMD. Burn care of the elderly[J]. J Burn Care Res, 2017,38(3):e625-e628. DOI: 10.1097/BCR.0000000000000535.
    [4]
    LiuY, ChenJJ, CrookN, et al. Epidemiologic investigation of burns in the elderly in Sichuan Province[J]. Burns, 2013,39(3):389-394. DOI: 10.1016/j.burns.2012.04.012.
    [5]
    秦小锋, 赵宇辉. 大面积严重烧伤住院患者流行病学分析[J/CD].中华损伤与修复杂志(电子版),2021,16(5):417-426. DOI: 10.3877/cma.j.issn.1673-9450.2021.05.008.
    [6]
    FarinasAF, BambaR, PollinsAC, et al. Burn wounds in the young versus the aged patient display differential immunological responses[J]. Burns, 2018,44(6):1475-1481. DOI: 10.1016/j.burns.2018.05.012.
    [7]
    NishioN, OkawaY, SakuraiH, et al. Neutrophil depletion delays wound repair in aged mice[J]. Age (Dordr), 2008,30(1):11-19. DOI: 10.1007/s11357-007-9043-y.
    [8]
    SharmaG, GoodwinJ. Effect of aging on respiratory system physiology and immunology[J]. Clin Interv Aging, 2006,1(3):253-260. DOI: 10.2147/ciia.2006.1.3.253.
    [9]
    MalachowskaB, YangWL, QualmanA, et al. Transcriptomics, metabolomics, and in-silico drug predictions for liver damage in young and aged burn victims[J]. Commun Biol, 2023,6(1):597. DOI: 10.1038/s42003-023-04964-2.
    [10]
    JeschkeMG, MicakRP, FinnertyCC, et al. Changes in liver function and size after a severe thermal injury[J]. Shock, 2007,28(2):172-177. DOI: 10.1097/shk.0b013e318047b9e2.
    [11]
    JeschkeMG. The hepatic response to thermal injury: is the liver important for postburn outcomes?[J]. Mol Med, 2009, 15(9/10):337-351.DOI: 10.2119/molmed.2009.00005.
    [12]
    GongY, LongXM, XuH, et al. The changes and prognostic value of liver function in young adults with severe burn: a retrospective observational study[J]. Medicine (Baltimore), 2018,97(51):e13721. DOI: 10.1097/MD.0000000000013721.
    [13]
    AugerC, SamadiO, JeschkeMG. The biochemical alterations underlying post-burn hypermetabolism[J]. Biochim Biophys Acta Mol Basis Dis, 2017,1863(10 Pt B):2633-2644. DOI: 10.1016/j.bbadis.2017.02.019.
    [14]
    ThaljiSZ, KothariAN, KuoPC, et al. Acute kidney injury in burn patients: clinically significant over the initial hospitalization and 1 year after injury: an original retrospective cohort study[J]. Ann Surg, 2017, 266(2): 376-382. DOI: 10.1097/SLA.0000000000001979.
    [15]
    RehouS, ShahrokhiS, ThaiJ, et al. Acute phase response in critically ill elderly burn patients[J]. Crit Care Med, 2019, 47(2): 201-209. DOI: 10.1097/CCM.0000000000003516.
    [16]
    ThwaitesRS, GunawardanaNC, BroichV, et al. Biphasic activation of complement and fibrinolysis during the human nasal allergic response[J]. J Allergy Clin Immunol, 2018,141(5):1892-1895.e6. DOI: 10.1016/j.jaci.2018.01.022.
    [17]
    LeviM, van der PollT. Coagulation and sepsis[J]. Thromb Res, 2017,149:38-44. DOI: 10.1016/j.thromres.2016.11.007.
    [18]
    马琪敏, 刘晓彬, 伍国胜, 等. 特重度成年烧伤患者休克期凝血特征及其预警价值的回顾性队列研究[J].中华烧伤杂志,2021,37(2):150-156. DOI: 10.3760/cma.j.cn501120-20200907-00402.
    [19]
    DhopteA, BamalR, TiwariVK. A prospective analysis of risk factors for pediatric burn mortality at a tertiary burn center in North India[J/OL]. Burns Trauma, 2017,5:30[2023-08-08]. https://pubmed.ncbi.nlm.nih.gov/28944226/.DOI: 10.1186/s41038-017-0095-7.
    [20]
    GirlichC, HoffmannU, BollheimerC. Treatment of type 2 diabetes in elderly patients[J]. Internist (Berl), 2014,55(7):762-768. DOI: 10.1007/s00108-014-3466-1.
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