Analysis of factors associated with mortality in major burn patients
Cem Emir Güldoğan1, Murat Kendirci2, Emre Gündoğdu1, Ahmet Çınar Yastı3
1Clinic of General Surgery, Ankara Liv Hospital, Ankara, Turkey
2Clinic of General Surgery, Hitit University Training and Research Hospital, Çorum, Turkey
3Clinic of General Surgery, Ankara Numune Training and Research Hospital, Ankara, Turkey
Objective: Major burn injury is a type of trauma with high morbidity and mortality rates at all age groups. There is no consensus on the provided guidelines regarding the prediction of severity of the victims. Not being accessible to sophisticated clinical and blood monitoring in developing countries, it remains a challenge for them. The aim of the present study was to analyze the factors that have an effect on mortality and serve as a guide for burn treatment. Factors affecting mortality in major burn patients treated in a burn treatment center of a third step hospital with over 30% of burns of the total body surface area were evaluated, and parameters indicating severity were specifically determined.
Material and Methods: Medical records and follow-up notes of patients hospitalized in Ankara Numune Education and Research Hospital Burn Center between 2008 and 2014 were evaluated retrospectively. Data on age, gender, comorbidities, burn percentage, locality, type of burn, process of the burn (suicide or accident), presence of inhalation injury, results of blood hemogram and biochemical tests, length of hospitalization, type of surgical procedures performed, presence of multitrauma, and ventilatory support requirement were analyzed to determine the factors affecting mortality. White blood cell count, hemoglobin count, platelet count, and lactate dehydrogenase level were examined at admission, at the middle of the clinical course, and at the end of treatment (at both exitus date or discharge date).
Results: A total of 224 patients were hospitalized with burns ≥ 30% total body surface area. Of the 224 patients, 81.7% were males, and 18.4% were females. In the mortality group, 41.3% were males, and 58.5% were females. Gender (female, p< 0.041), age (p< 0.001), age group (0–14/15–59/> 60 years, p< 0.001), total body surface area (p< 0.001), type of burn (flame, p< 0.002), presence of inhalation injury (p< 0.001), process of the burn (p< 0.002), time spent between the event and admission to the hospital (p< 0.001), length of hospitalization (p< 0.001), presence of comorbidity (p< 0.038), diabetes mellitus (p< 0.05), ventilation support (p< 0.001), lactate dehydrogenase values (lactate dehydrogenaseadmission, p< 0.001; lactate dehydrogenasemiddle, p< 0.015; lactate dehydrogenaselast, p< 0.001), white blood cell count (p< 0.001), and platelet count (p< 0.043) were found to be significant for univariate analyses. These parameters were further evaluated using multivariate analyses. Lactate dehydrogenaselast level (p< 0.001), age (p< 0.001), length of hospitalization (negative odds ratio), p< 0.001), presence of inhalation injury (p< 0.029), total body surface area burned (p< 0.029), and leukocytosis (p< 0.006) were found to be significantly associated with mortality; however, leukocytosis and length of hospitalization did not pose risk for mortality with regard to odds ratios.
Conclusion: Early recognition of the factors affecting morbidity and mortality in patients and taking preventive measures, in addition to earlier detection and prevention of complications in long-time intensive care unit patients, could reduce complication and mortality rates in major burn trauma patients. Parameters for the indication of severity and mortality are important; however, lactate dehydrogenase is an easily studied parameter and is found to have a predictive value on prognosis.
Keywords: Burn, major burn, burn and mortality
Cite this article as: Güldoğan CE, Kendirci M, Gündoğdu E, Yastı AÇ. Analysis of factors associated with mortality in major burn patients. Turk J Surg 2019; 35 (3): 155-164.
Ethics committee approval was received for this study from the Ethics Committee of Ankara Numune Education and Research Hospital.
Not required in this study.
Concept - C.E.G., A.Y.; Design - C.E.G., M.K.; Supervision - A.Y.; Resource - C.E.G., E.G.; Materials - C.E.G., A.Y.; Data Collection and/or Processing - C.E.G., M.K., E.G.; Analysis and/or Interpretation - C.E.G., A.Y.; Literature Search - C.E.G.; Writing Manuscript - C.E.G., A.Y.; Critical Reviews - A.Y.
The authors have no conflicts of interest to declare.
The authors declared that this study has received no financial support.