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

Zhonghua Shao Shang Yu Chuang Mian Xiu Fu Za Zhi. 2024 Mar 20;40(3):249-257. doi: 10.3760/cma.j.cn501225-20230808-00042.
[Article in Chinese]

Abstract

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 924th 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/m2, 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 χ2 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.

目的: 探讨危重烧伤老年患者早期临床特征及预后的危险因素。 方法: 该研究为回顾性病例系列研究。收集2015年1月—2020年12月12家医院收治的符合入选标准的124例危重烧伤老年患者的临床资料,其中大连市第四人民医院4例、福建医科大学附属协和医院5例、暨南大学附属广州市红十字会医院22例、黑龙江省医院5例、海军军医大学第一附属医院27例、南昌大学第一附属医院9例、南通大学附属医院10例、武汉大学同仁医院暨武汉市第三医院9例、解放军第924医院12例、张家港市第一人民医院6例、浙江省台州医院4例、郑州市第一人民医院11例。统计患者的总体临床特征,包括性别、年龄、体重指数、烧伤总面积、Ⅲ度烧伤面积、吸入性损伤情况、致伤因素、是否合并基础疾病以及伤后入院时间。根据伤后28 d内的存活结局,将患者分为存活组(89例)与死亡组(35例),比较2组患者基本资料与伤情(同前总体临床特征);伤后第1个24 h凝血指标,包括凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶时间、D-二聚体、纤维蛋白降解产物(FDP)、国际标准化比值(INR)、纤维蛋白原;伤后第1个24 h血常规指标,包括白细胞计数、血小板计数、中性粒细胞与淋巴细胞比值、单核细胞计数、红细胞计数、血红蛋白、血细胞比容;伤后第1个24 h脏器功能指标,包括直接胆红素、总胆红素、尿素、血肌酐、天冬氨酸转氨酶、丙氨酸转氨酶、总蛋白、白蛋白、球蛋白、血糖、甘油三酯、总胆固醇、碱性磷酸酶、肌酸激酶、电解质指标(血钾、血钠、血氯、血钙、血镁及血磷)、尿酸、肌红蛋白、脑钠肽;伤后第1个24 h感染及血气指标,包括降钙素原、C反应蛋白、pH值、氧合指数、碱剩余、乳酸;治疗情况,包括是否行机械通气、是否行连续性肾脏替代治疗、是否行抗凝治疗、是否应用血管活性药及液体复苏情况。筛选影响危重烧伤老年患者伤后28 d死亡的独立危险因素。 结果: 124例患者中男82例、女42例,年龄60~97岁,体重指数23.44(21.09,25.95)kg/m2,烧伤总面积54.00%(42.00%,75.00%)体表总面积(TBSA),Ⅲ度烧伤面积25.00%(10.00%,40.00%)TBSA,主要为中重度吸入性损伤,以火焰烧伤者为主,合并基础疾病者43例,以伤后入院时间≤8 h者为主。2组患者年龄,烧伤总面积,Ⅲ度烧伤面积,吸入性损伤情况,伤后第1个24 h PT、APTT、D-二聚体、FDP、INR、白细胞计数、血小板计数、尿素、血肌酐、血糖、血钠、尿酸、肌红蛋白、尿量比较,差异均有统计学意义(Z值分别为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、-3.82,P<0.05);是否行机械通气、是否应用血管活性药比较,差异均有统计学意义(χ2值分别为9.44、28.50,P<0.05)。年龄、烧伤总面积、Ⅲ度烧伤面积、伤后第1个24 h血肌酐、伤后第1个24 h APTT均为危重烧伤老年患者伤后28 d死亡的独立危险因素(比值比分别为1.17、1.10、1.10、1.09、1.27,95%置信区间分别为1.03~1.40、1.04~1.21、1.05~1.19、1.05~1.17、1.07~1.69,P<0.05)。 结论: 危重烧伤老年患者多为火焰烧伤,常伴随中重度吸入性损伤,早期常伴有炎症反应增强、血糖升高、纤溶激活、脏器功能损害等,这与其预后相关。年龄、烧伤总面积、Ⅲ度烧伤面积、伤后第1个24 h血肌酐和APTT是该群体伤后28 d死亡的独立危险因素。.

Publication types

  • Multicenter Study
  • English Abstract

MeSH terms

  • Aged
  • Bilirubin
  • Blood Glucose*
  • Burns* / diagnosis
  • Creatinine
  • Female
  • Fibrin Fibrinogen Degradation Products
  • Humans
  • Lactic Acid
  • Male
  • Myoglobin
  • Prognosis
  • Retrospective Studies
  • Risk Factors
  • Sodium
  • Urea
  • Uric Acid

Substances

  • Blood Glucose
  • Creatinine
  • Myoglobin
  • Uric Acid
  • Lactic Acid
  • Fibrin Fibrinogen Degradation Products
  • Bilirubin
  • Sodium
  • Urea