Multicenter retrospection and analysis of influencing factors on blood transfusion in patients with extensive burns

Duan Deqing; Chen Yong; Deng Hong'ao; Hu Shiqiang; Mao Yuangui; Liu Dewu; Han Chunmao; Xu Qinglian; Zhang Hongyan

doi:10.3760/cma.j.cn501225-20230417-00128

Volume 39 Issue 11

Nov. 2023

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Article Navigation > CHINESE JOURNAL OF BURNS AND WOUNDS > 2023 > 39(11): 1047-1056

Duan DQ,Chen Y,Deng HA,et al.Multicenter retrospection and analysis of influencing factors on blood transfusion in patients with extensive burns[J].Chin J Burns Wounds,2023,39(11):1047-1056.DOI: 10.3760/cma.j.cn501225-20230417-00128.

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Multicenter retrospection and analysis of influencing factors on blood transfusion in patients with extensive burns

doi: 10.3760/cma.j.cn501225-20230417-00128

1.
Medical Center of Burn Plastic and Wound Repair, the First Affiliated Hospital of Nanchang University, Nanchang 330006, China
2.
Department of Burn and Wound Repair, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, China
3.
Department of Burns, the First Affiliated Hospital of Anhui Medical University, Hefei 230022, China

Funds:

Regional Science Foundation Program of National Natural Science Foundation of China 30960401, 82360450

Natural Science Foundation of Jiangxi Province of China 20181BAB205041

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Corresponding author: Zhang Hongyan, Email: zhycn2008@163.com
Received Date: 2023-04-17

Abstract

Abstract

Objective To retrospect the blood transfusion status of patients with extensive burns in multiple centers and analyze its influencing factors. Methods A retrospective case series study was conducted. Clinical data of 455 patients with extensive burns who met the inclusion criteria and were admitted to the burn centers of 3 hospitals from January 2016 to June 2022 were collected, including 202 patients from the First Affiliated Hospital of Nanchang University, 179 patients from the Second Affiliated Hospital of Zhejiang University School of Medicine, and 74 patients from the First Affiliated Hospital of Anhui Medical University. The following data were collected from patients during their hospitalization, including infusion of red blood cells, plasma, and platelets during hospitalization; age, gender, body mass index, combined underlying diseases, cause of injury, time of admission after injury, type of admission, total burn area, full-thickness burn area, combination of inhalation injury, combination of other trauma, and combination of pulmonary edema; the blood lactic acid, serum creatinine, total bilirubin, and albumin values within 24 h of admission; combination of bloodstream, wound, lung, and urinary tract infection, and combination of sepsis; the number of escharectomy or tangential excision and skin grafting surgery (hereinafter referred to as surgery) and total surgical blood loss volume; occurrence of hemoglobin<70 g/L, admission to intensive care unit (ICU), conduction of mechanical ventilation and continuous renal replacement therapy (CRRT), length of hospital stay, and prognosis were recorded. In 602 surgeries of patients within 14 days after injury, data including area of escharectomy or tangential excision and skin graft harvesting, duration of operation, and surgical blood loss volume per surgery, operation site, and use of tourniquet and wound graft were collected. Data were statistically analyzed with Mann-Whitney U test, Kruskal-Wallis H test, and Spearman correlation analysis. Combined with the results of single factor analysis and clinical significance, multiple linear regression analysis was performed to screen the independent influencing factors of red blood cell infusion volume and plasma infusion volume, as well as blood loss volume per surgery. Results During the whole hospitalization period, 437 (96.0%) patients received blood transfusion therapy, including 435 (95.6%) patients, 410 (90.1%) patients, and 73 (16.0%) patients who received transfusion of plasma, red blood cells, and platelets, respectively. The patients were mainly male, aged 18 to 92 years. There were statistically significant differences in the plasma infusion volume among patients with different combination of underlying disease, combination of inhalation injury, combination of other trauma, combination of pulmonary edema, combination of bloodstream infection, combination of wound infection, combination of lung infection, combination of urinary tract infection, combination of sepsis, occurrence of hemoglobin value <70 g/L, admission to ICU, conduction of mechanical ventilation, and conduction of CRRT (with Z values of -2.06, -4.67, -2.11, -6.13, -9.56, -4.93, -8.08, -4.78, -9.12, -6.55, -9.37, -11.46, and -7.17, respectively, P<0.05). The total burn area, full-thickness burn area, blood lactic acid value within 24 h of admission, serum creatinine value within 24 h of admission, albumin value within 24 h of admission, number of surgeries, and total surgical blood loss volume were correlated with the plasma infusion volume of patients (with r values of 0.39, 0.51, 0.14, 0.28, -0.13, 0.47, and 0.56, respectively, P<0.05).There were statistically significant differences in the red blood cell infusion volume among patients with different gender, combination of inhalation injury, combination of other trauma, combination of pulmonary edema, combination of bloodstream infection, combination of wound infection, combination of lung infection, combination of urinary tract infection, combination of sepsis, occurrence of hemoglobin value <70 g/L, admission to ICU, conduction of mechanical ventilation, and conduction of CRRT (with Z values of -2.00, -4.34, -3.10, -4.22, -8.24, -7.66, -8.62, -4.75, -7.42, -9.36, -6.12, and -8.31, -6.64, respectively, P<0.05). The age, total burn area, full-thickness burn area, blood lactic acid value within 24 h of admission, serum creatinine value within 24 h of admission, total bilirubin value within 24 h of admission, number of surgeries, and total surgical blood loss volume were correlated with the red blood cell infusion volume of patients (with rvalues of 0.12, 0.22, 0.49, 0.09, 0.18, 0.13, -0.15, 0.69, and 0.77, respectively, P<0.05). Combined underlying diseases, full-thickness burn area, combined pulmonary edema, serum creatinine value within 24 h of admission, combined sepsis, conduction of CRRT, number of surgeries, and total surgical blood loss volume were the independent influencing factors for plasma infusion volume during hospitalization in patients with extensive burns (with standardized regression coefficients of 0.09, 0.16, 0.12, 0.07, 0.11, 0.15, 0.31, and 0.26, respectively, P<0.05). Female, full-thickness burn area, serum creatinine value within 24 h of admission, combined sepsis, occurrence of hemoglobin value <70 g/L, conduction of CRRT, and total surgical blood loss volume were the independent influencing factors for red blood cell infusion volume during hospitalization in patients with extensive burns (with standardized regression coefficients of 0.10, 0.12, 0.10, 0.11, 0.05, 0.19, and 0.54, respectively, P<0.05). There were statistically significant differences in blood loss volume per surgery of patients with different surgical site and wound graft (with Z values of -2.54 and -2.27, respectively, P<0.05). The area of escharectomy or tangential excision and skin graft harvesting and duration of operation were correlated with the blood loss volume per surgery of patients (with r values of 0.40 and 0.21, respectively, P<0.05). The area of escharectomy or tangential excision and skin graft harvesting, duration of operation, and active wound grafts were the independent influencing factors for blood loss volume per surgery of patients with extensive burns (with standardized regression coefficients of 0.41, 0.16, and 0.12, respectively, P<0.05). Conclusions The major factors influencing blood transfusion status in patients with extensive burns are female, combined underlying diseases, full-thickness burn area, serum creatinine value within 24 h of admission, combined pulmonary edema, occurrence of hemoglobin value <70 g/L, combined sepsis, conduction of CRRT, number of surgery, and total surgical blood loss volume. In addition, the area of escharectomy or tangential excision and skin graft harvesting, duration of operation, and active wound grafts indirectly affect the patient's blood transfusion status by affecting the blood loss volume per surgery.
- Burns,
- Blood transfusion,
- Blood loss, surgical,
- Root cause analysis

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References

[1]	SuK, XueFS, XueZJ, et al. Clinical characteristics and risk factors of early acute kidney injury in severely burned patients[J]. Burns, 2021,47(2):498-499. DOI: 10.1016/j.burns.2020.08.018.
[2]	郭光华, 江政英. 危重烧伤救治的过去与现在和将来[J].中华烧伤杂志,2021,37(10):905-910. DOI: 10.3760/cma.j.cn501120-20210209-00055.
[3]	PalmieriTL. Transfusion and infections in the burn patient[J]. Surg Infect (Larchmt), 2021,22(1):49-53. DOI: 10.1089/sur.2020.160.
[4]	PalmieriTL, CarusoDM, FosterKN, et al. Effect of blood transfusion on outcome after major burn injury: a multicenter study[J]. Crit Care Med, 2006,34(6):1602-1607. DOI: 10.1097/01.CCM.0000217472.97524.0E.
[5]	WuGS, ZhuangMZ, FanXM, et al. Blood transfusions in severe burn patients: epidemiology and predictive factors[J]. Burns, 2016,42(8):1721-1727. DOI: 10.1016/j.burns.2016.06.002.
[6]	KilyewalaC, AlenyoR, SsentongoR. Determinants and time to blood transfusion among thermal burn patients admitted to Mulago Hospital[J]. BMC Res Notes, 2017,10(1):258. DOI: 10.1186/s13104-017-2580-2.
[7]	CartottoR, TaylorSL, HolmesJH, et al. Inhalation injury does not influence the amount of blood transfused to major burn patients: a secondary analysis from the transfusion requirement in burn care evaluation study[J]. J Burn Care Res, 2019,40(6):757-762. DOI: 10.1093/jbcr/irz129.
[8]	YogoreMG3rd, BoralL, Kowal-VernA, et al. Use of blood bank services in a burn unit[J]. J Burn Care Res, 2006,27(6):835-841. DOI: 10.1097/01.BCR.0000245418.73538.25.
[9]	王默然, 王峻, 葛艳玲. 烧伤患者住院期间用血情况影响因素的回顾性分析[J].中国输血杂志,2021,34(2):143-146. DOI: 10.13303/j.cjbt.issn.1004-549x.2021.02.012.
[10]	JinJ, PengY, ChenZL, et al. Determining transfusion use in major burn patients: a retrospective review and analysis from 2009 to 2019[J]. Burns, 2022,48(5):1104-1111. DOI: 10.1016/j.burns.2021.09.004.
[11]	PruittBAJr. Protection from excessive resuscitation: "pushing the pendulum back"[J]. J Trauma, 2000,49(3):567-568. DOI: 10.1097/00005373-200009000-00030.
[12]	D'AbbondanzaJA, ShahrokhiS. Burn infection and burn sepsis[J]. Surg Infect (Larchmt), 2021,22(1):58-64. DOI: 10.1089/sur.2020.102.
[13]	RygårdSL, ButlerE, GranholmA, et al. Low-dose corticosteroids for adult patients with septic shock: a systematic review with meta-analysis and trial sequential analysis[J]. Intensive Care Med, 2018,44(7):1003-1016. DOI: 10.1007/s00134-018-5197-6.
[14]	GreenhalghDG. Sepsis in the burn patient: a different problem than sepsis in the general population[J/OL]. Burns Trauma, 2017, 5: 23[2023-10-16].https://pubmed.ncbi.nlm.nih.gov/28795054/.DOI: 10.1186/s41038-017-0089-5.
[15]	FuzaylovG, AndersonR, LeeJ, et al. Blood transfusion trigger in burns: a four-year retrospective analysis of blood transfusions in eleven burn centers in Ukraine[J]. Ann Burns Fire Disasters, 2015,28(3):178-182.
[16]	龚德华, 贾凤玉. 重症烧伤患者救治中CRRT的应用[J].中国血液净化,2016,15(7):321-324. DOI: 10.3969/j.issn.1671-4091.2016.07.001.
[17]	MaiL, SpilsburyK, EdgarDW, et al. Increased risk of blood transfusion in patients with diabetes mellitus sustaining non-major burn injury[J]. Burns, 2020,46(4):888-896. DOI: 10.1016/j.burns.2019.10.016.
[18]	RizzoJA, RossE, OstrowskiML, et al. Intraoperative blood transfusions in burn patients[J]. Transfusion, 2021,61 Suppl 1:S183-187. DOI: 10.1111/trf.16505.
[19]	李培龙, 王芳, 宋国栋, 等. 大面积深度烧伤患者削痂植皮失血量及其影响因素分析[J].中华烧伤杂志,2017,33(2):111-114. DOI: 10.3760/cma.j.issn.1009-2587.2017.02.012.
[20]	CartottoR, MusgraveMA, BeveridgeM, et al. Minimizing blood loss in burn surgery[J]. J Trauma, 2000,49(6):1034-1039. DOI: 10.1097/00005373-200012000-00010.
[21]	KS A, KumarP, SubairM, et al. Effect of single dose intravenous tranexamic acid on blood loss in tangential excision of burn wounds - a double blind randomised controlled trial[J]. Burns, 2022, 48(6): 1311-1318. DOI: 10.1016/j.burns.2021.08.021.