Clinical Features And Treatment Outcome Of The Elderly Patients With Severe Burns In Early Stage

Background:The senile severe burn has the characteristics of high incidence and high mortality,which is different from that of young and middle-aged burns.The purpose of this study was to describe the early clinical characteristics and treatment outcomes of elderly patients with severe burn,in order to provide some reference for the treatment of elderly patients with severe burn.Method:Adult patients（≥18 years old）with severe burns in the First Affiliated Hospital of Nanchang University burn department from January 1st,2017 to June 30th,2022were enrolled.According to the age of the patients,patients aged 18 years or older and 59 years or younger were divided into the young and middle-aged group,and patients aged 60 years or older were divided into the elderly group,and the clinical characteristics and treatment outcome of elderly compared with young and middle-aged patients with severe burns were analyzed.The data were analyzed by independent sample t-test,chi-square test or Fisher’s exact probability test,and the patients were divided into survival and death groups according to the prognosis within 28 day after burn injury,binary multivariate logistic regression was used to analyze the risk factors for death in young and middle-aged patients and elderly patients.Results:（1）General Information:A total of 315 patients with severe burns were included in this study,including 262 young and middle-aged patients and 53 elderly patients.Compared with the young and middle-aged group,the elderly group had higher proportion of hypertension,diabetes,cerebral infarction and other basic diseases before burn injury,higher Baux score and APACHEⅡscore on admission,lower proportion of surgical treatment,higher incidence of complications such as cardiac insufficiency,AKI and ARDS during hospitalization,longer ICU stay,shorter total hospital stay,longer length of ICU stay,shorter total hospital stay.higher The 28 days case fatality rate（P<0.05 or P<0.01）.（2）Fluid replacement volume and urine volume:There was no statistically significant difference in the fluid replacement volume of patients in the two groups during the first and second 24h post injury（t=1.514,0.804,P>0.05）,and the urine volume during the first and second 24h post injury in elderly group was significantly less than that in young and middle-aged group（t=4.568,2.587,P<0.05 or P<0.01）.（3）Vital sign index:The heart rate of the elderly group at admission and shock stage was significantly lower than that of the young and middle-aged group（t=2.033,3.476,P<0.05）,and there was no significant difference between the two groups at3-5 days after injury（t=1.219,P>0.05）.There were no significant differences in respiratory rate and systolic blood pressure at admission,shock stage and 3-5 days after injury（t=0.360,1.110,0.821,0.668,0.387,0.863,P>0.05）.The diastolic blood pressure level in the elderly group at admission and shock stage was significantly lower than that in the young and middle-aged group（t=2.160,2.507,P<0.05）,and there was no significant difference in the diastolic blood pressure level at 3-5 days after injury between the two groups（t=1.726,P>0.05）.The level of blood oxygen saturation in the elderly group was significantly lower than that in the young and middle-aged group at shock stage（t=3.549,P<0.01）,and there was no significant difference between the two groups at admission and 3-5 days after injury（t=1.344,1.425,P>0.05）.（4）Blood routine index:The white blood cell count and neutrophil count levels in the elderly group were significantly lower than those in the young and middle-aged group at each time point（t=5.581,3.363,2.524,6.476,2.834,2.539,P<0.05 or P<0.01）.The lymphocyte count level at shock stage and 3-5 days after injury in the elderly group was significantly lower than that in the young and middle-aged group（t=2.031,2.086,P<0.05 or P<0.01）,and there was no significant difference between the two groups on admission（t=0.997,P>0.05）.The platelet count level of the elderly group at admission and shock stage was significantly lower than that of the young and middle-aged group（t=5.139,2.608,P<0.05 or P<0.01）,and there was no significant difference in the platelet level at 3-5 days after injury between the two groups（t=1.745,P>0.05）.There were no significant differences in neutrophil/lymphocyte ratio and platelet/lymphocyte ratio between 2 groups at each time point（t=1.245,-0.276,-0.308,-0.369,-0.667,-1.490,P>0.05）.The level of systemic immune inflammatory index in the elderly group at admission and shock stage was significantly lower than that in the young and middle-aged group（t=4.094,2.627,P<0.05 or P<0.01）,and there was no significant difference in the level of systemic immune inflammatory index at 3-5 days after injury between the two groups（t=0.158,P>0.05）.（5）Blood biochemical index:The CK level in the elderly group at admission and shock stage was significantly higher than that in the young and middle-aged group（t=-2.077,-2.189,P<0.05）,and there was no significant difference in the 3-5d CK level between the two groups after injury（t=-1.937,P>0.05）.The level of CK-MB in the elderly group was significantly higher than that in the young and middle-aged group at each time point（t=-2.130,-2.910,-2.286,P<0.05）.The level of total bilirubin in the elderly group at admission and shock stage was significantly higher than that in the young and middle-aged group（t=-2.141,-2.915,P<0.05）,and there was no significant difference in the level of total bilirubin at 3-5 days after injury between the two groups（t=-1.624,P>0.05）.There was no significant difference in albumin level between 2 groups at each time point（t=0.365,1.073,0.838,P>0.05）.The levels of creatinine and urea nitrogen in the elderly group were significantly higher than those in the young and middle-aged group at all time points（t=-2.044,-2.553,-1.983,-3.396,-3.382,-3.550,P<0.05）.The blood glucose level in the elderly group at admission and shock stage was significantly higher than that in the young and middle-aged group（t=-2.522,-2.455,P<0.05）,and there was no significant difference in the blood glucose level at 3-5 days after injury between the two groups（t=-0.318,P>0.05）.（6）Blood gas analysis index:There was no significant difference in PH level between the two groups at each time point（t=-0.681,-1.565,-1.145,P>0.05）.The Pa O₂ level in the elderly group at admission and shock stage was significantly lower than that in the young and middle-aged group（t=2.556,2.345,P<0.05）,and there was no significant difference in Pa O₂ level at 3-5 days after injury between the two groups（t=1.687,P>0.05）.Pa CO₂ level in the aged group was significantly lower than that in the young and middle-aged group（t=3.537,2.396,3.329,P<0.05 or P<0.01）.The HCO₃^-level in the elderly group was significantly lower than that in the young and middle-aged group at admission（t=2.276,P<0.05）,and there was no significant difference in the HCO₃^-level at shock stage and 3-5 days after injury between the two groups（t=1.040,-0.666,P>0.05）.The residual level of point alkali in the aged group was significantly higher than that in the young and middle-aged group（t=2.365,2.043,2.164,P<0.05）.The blood lactic acid level of the elderly group at admission and shock stage was significantly higher than that of the young and middle-aged group（t=-1.248,-2.206,P<0.05）,and there was no significant difference in blood lactic acid level at 3-5 days after injury between the two groups（t=-1.315,P>0.05）.The oxygenation index level of the aged group was significantly lower than that of the young and middle-aged group at each time point（t=2.191,2.143,2.913,P<0.05）.（7）Prognostic analysis:There were 41 patients died in the 2 groups,including28 cases in young and middle-aged patients and 13 cases in elderly patients.The age total burn area,third-degree burn area,Baux score,APACHE II score,the incidence of pulmonary infection and sepsis were greater higher in the young and middle-aged death group than in the young and middle-aged survival group（P<0.05 or P<0.01）.Logistic regression analysis showed that the Baux score（OR=1.126,95%CI=1.077-1.176,P=0）and incidence of sepsis（OR=4.721,95%CI=1.087-20.516,P=0.038）were risk factors for death in young and middle-aged patients.The total burn area,third-degree burn area,Baux score,proportion of pre-injury combined diabetes,and incidence of AKI were greater or higher in the elderly death group than elderly survival group,and the proportion of surgical treatment was lower in the elderly death group than elderly survival group（P<0.05 or P<0.01）.Logistic regression analysis showed that Baux score（OR=1.068,95%CI=1.322-68.387,P=0.027）and the incidence of AKI（OR=2.252,95%CI=1.322-68.387,P=0.025）were risk factors for death in elderly patients,and surgical treatment（OR=-2.325,95%CI=0.014-0.685,P=0.019）was a protective factor for death in elderly patients.Conclusion:Elderly patients with severe burn in early stage have low tissue circulation perfusion,suppressed immune and inflammatory response,and serious organ damage,resulting in long length of ICU stay,more complications,and high mortality rate.Therefore,clinical attention should be paid to the treatment of elderly burn patients.