Relationship Between Clinical Predictors Of Early Stage And Prognosis In Severely Burn Patients

[OBJECTIVE]Burn patients lose the first barrier to infection,their skin.The burn patient is continuously exposed to inflammatory mediators as long as the wound remains open.When there are extensive burns the exposure to pathogens will persist for months.Therefore,all major burns will have a persistent SIRS,hypermetabolic response,disturbance of homeostasis,sepsis,and even MODS.An increased possibility of morbidity and mortality was found in severely burn patients with sepsis and MODS.Therefore,it is beneficial to improve clinical therapy and decrease mortality by providing prognostic predictors for mortality risk assessment in severely burned patients.[METHODS]In the retrospective study,the clinical data sach as burned area,full thickness burn area,APACHE-Ⅱ score,Baux score,platelet counts,adjusted serum calcium,length of hospital stay and etc.were collected in both adult and pediatric burn patients admitted to our burn center during period of year 2006 to year 2017.The relationships between the patient demographics,laboratory results and patient outcomes were analyzed by using methods of ROC,Kaplan-Meier,multiple logistic regressions analysis.Meanwhile,factors influencing length of hospital stay and predictors affecting probability of requiring surgery in severely pediatric burn patients also explored in the study.[RESULTS]1.TheΔPC/ΔT associated with the best discrimination between survivors and non-survivors was 20.57×10~9/L due to the cutoff with optimal Youden index(0.453).By multiple logistic regression,ΔPC/ΔT<20.57×10~9/L was one of prognostic predictors of 30-day mortality.Furthermore,Kaplan-Meier estimates of hospital survival according to the size ofΔPC/ΔT revealed that a blunted increase with ΔPC/ΔT<20.57×10~9/L was associated with increased 30-day mortality.2.The optimal cutoff value ofΔAdjCC/ΔT from day 3 to 9,distinguished from survivors and non-survivors,was 0.01083 according to the maximum Youden index(0.2819).Moreover,Kaplan-Meier and multiple logistic regression demonstrated thatΔAdjCC/ΔT>0.01083 mmol/L was independently related to decreased 30-day mortality.3.After multiple linear regression,Surgery,%TBSA,days to surgery,etiology, infection and erythrocyte changes were significantly associated with length of hospital stay.The overall percent full thickness,infection and erythrocyte changes over 5 days post-admission were significantly associated with the probability of requiring surgery.[CONCLUSION]In conclusion,a blunted daily increase in PCs,especiallyΔPC/ΔT<20.57×109/L,is associated with increased 30-day mortality,which provides prognostic information for mortality risk assessment in severely burned patients.The early increase of AdjCC,especiallyΔAdjCC/ΔT>0.01083 mmol/L,serves as a novel prognostic index for 30-day mortality in severely burned patients.In pediatric burn patients,the main factors of length of stay were surgery,%TBSA,days to surgery,etiology,erythrocyte changes and infection.Furthermore the pivotal predictors of probability requiring surgery were%FT,infection and erythrocyte changes.