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Volume 40 Issue 11
Nov.  2024
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Article Navigation >  CHINESE JOURNAL OF BURNS AND WOUNDS  > 2024  >  40(11): 1024-1033
Huang SY,Ma QM,Wang YS,et al.A multicenter study on the impact of the early infusion rate on prognosis and the factors of influencing the infusion rate in patients with severe burns and inhalation injury[J].Chin J Burns Wounds,2024,40(11):1024-1033.DOI: 10.3760/cma.j.cn501225-20240409-00130.
Citation: Huang SY,Ma QM,Wang YS,et al.A multicenter study on the impact of the early infusion rate on prognosis and the factors of influencing the infusion rate in patients with severe burns and inhalation injury[J].Chin J Burns Wounds,2024,40(11):1024-1033.DOI: 10.3760/cma.j.cn501225-20240409-00130.
shu

A multicenter study on the impact of the early infusion rate on prognosis and the factors of influencing the infusion rate in patients with severe burns and inhalation injury

doi: 10.3760/cma.j.cn501225-20240409-00130
  • 1.

    Medical Center of Burn Plastic and Wound Repair, the First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang330006, China

  • 2.

    Department of Critical Care Medicine, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai200120, China

  • 3.

    Department of Burn Trauma and Wound Repair, the First Affiliated Hospital of Naval Medical University, Shanghai200433, China

  • 4.

    Department of Burns and Plastic Surgery, Guangzhou Red Cross Hospital of Jinan University, Guangzhou510220, China

  • 5.

    Department of Burns, Tongren Hospital of Wuhan University ＆ Wuhan Third Hospital, Wuhan430060, China

  • 6.

    Department of Burns and Plastic Surgery, the 924th Hospital of PLA, Guilin541002, China

  • 7.

    Department of Burns and Plastic Surgery, the Fourth People's Hospital of Dalian, Dalian116031, China

  • 8.

    Department of Burns, Zhengzhou First People's Hospital, Zhengzhou450004, China

Funds:

National Key Research and Development Program 2019YFA0110601

Shanghai Pudong New Area Summit Construction Project PWYgf2021-03

More Information
    Abstract
  •   Objective  To investigate the impact of the early infusion rate on prognosis and the factors of influencing the infusion rate in patients with severe burns and inhalation injury.  Methods  This study was a retrospective case series research. From January 2015 to December 2020, 220 patients with severe burns and inhalation injury meeting the inclusion criteria were admitted to 7 burn treatment centers in China, including 13 cases in the Fourth People's Hospital of Dalian, 26 cases in the First Affiliated Hospital of Naval Medical University, 73 cases in Guangzhou Red Cross Hospital of Jinan University, 21 cases in the 924th Hospital of PLA, 30 cases in the First Affiliated Hospital of Jiangxi Medical College of Nanchang University, 30 cases in Tongren Hospital of Wuhan University ＆ Wuhan Third Hospital, and 27 cases in Zhengzhou First People's Hospital. There were 163 males and 57 females, and their ages ranged from 18 to 91 years. The patients were divided into survival group and death group according to the survival within 28 d post injury. The following data of patients in the 2 groups were collected, including basic information (gender, age, body weight, body temperature, etc.), the injury characteristics (total burn area, post-injury admission time, etc.), the underlying diseases, the post-injury fluid resuscitation condition (infusion rate and ratio of infused electrolyte solution to colloid solution in the first 24 h post injury, etc.), the results of laboratory tests on admission (blood urea nitrogen, blood creatinine, albumin, pH value, base excess, blood lactate, oxygenation index, etc.), and treatment condition (inhaled oxygen volume fraction, hospitalization day, renal replacement therapy, etc.). After adjusting covariates using univariate Cox regression analysis, the multivariate Cox regression analysis was performed to evaluate the impact of infusion rate in the first 24 h post injury on patient death. The receiver operator characteristic curve for the infusion rate in the first 24 h post injury to predict the risk of death was plotted, and the maximum Youden index was calculated. Patients were divided into 2 groups according to the cutoff value (2.03 mL·kg-1·% total body surface area (TBSA)-1) for predicting risk of death by the infusion rate in the first 24 h post injury determined by the maximum Youden index, and the risk of death was compared between the 2 groups. The correlation between the previously mentioned clinical data and the infusion rate in the first 24 h post injury was analyzed; after the univariate linear regression analysis was used to screen the independent variables, the multivariate linear regression analysis was performed to screen the independent influential factors on the infusion rate in the first 24 h post injury.  Results  Compared with those in survival group, patients in death group had significantly higher age and total burn area (with Z values of 12.08 and 23.71, respectively, P<0.05), the infusion rate in the first 24 h post injury, inhaled oxygen volume fraction, and blood urea nitrogen, blood creatinine, blood lactic acid on admission (with Z values of 7.99, 4.01, 11.76, 23.24, and 5.97, respectively, P<0.05), and the proportion of patients treated with renal replacement therapy (P<0.05) were significantly higher, the albumin, pH value, and base excess on admission were significantly lower (t=2.72, with Z values of 8.18 and 9.70, respectively, P<0.05), and the hospitalization day was significantly reduced (Z=85.47, P<0.05). After adjusting covariates, the infusion rate in the first 24 h post injury was the independent influential factor on death (with standardized hazard ratio of 1.69, 95% confidence interval of 1.21-2.37, P<0.05). Patients in infusion rate ≥2.03 mL·kg-1·%TBSA-1 group had a significantly higher risk of death than those in infusion rate <2.03 mL·kg-1·% TBSA-1 group (with hazard ratio of 3.47, 95% confidence interval of 1.48-8.13, P<0.05). There was a significant correlation between total burn area, body weight, inhaled oxygen volume fraction, body temperature, post-injury admission time, the ratio of infused electrolyte solution to colloid solution in the first 24 h post injury, and oxygenation index <300 on admission and the infusion rate in the first 24 h post injury (with r values of -0.192, -0.215, 0.137, -0.162, -0.252, and 0.314, respectively, Z=4.48, P<0.05). After screening the independent variables, total burn area, body weight, post-injury admission time, and oxygenation index <300 on admission were the independent influential factors on the infusion rate in the first 24 h post injury (with standardized β values of -0.22, -0.22, -0.19, and 0.46, respectively, 95% confidence intervals of -0.34 to 0.09, -0.34 to 0.10, -0.32 to 0.06, and 0.22 to 0.71, respectively, P<0.05).  Conclusions  The infusion rate in the first 24 h post injury in patients with severe burns and inhalation injury is the independent factor of influencing death, and patients with infusion rate ≥2.03 mL·kg-1·%TBSA-1 in the first 24 h post injury have a significantly increased risk of death. The total burn area, body weight, post-injury admission time, and oxygenation index <300 on admission were the independent factors of influencing the infusion rate in the first 24 h post injury in patients with severe burns and inhalation injury.

     

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