Base Deficit, Serum Albumin Level And Blood Haemoglobin Concentration Can Be Used As Predictor Factors For Mortality In Major Burn Patients.

Hypoalbuminemia as seen in major burn injury results in widespread endothelial dysfunction. Base deficit provides the best estimate for degree of tissue anoxia. Acute blood loss describes anemia present in burn patients. Controversy focuses on the administration of protein-based colloids: whether to provide them, which solutions to use, and when to begin? The aim of this study was to determine whether alteration of gas exchange, excess base deficit, hypoalbuminemia and anemia could predict mortality in major burn patients, whether to provide protein-based colloids, and when to begin fluid resuscitation. The prospective study included 42 major burn patients. All the patients were admitted to the burn intensive care unit at Menoufia University Hospital. Serum albumin level, hemoglobin concentration, arterial blood gases and base deficit were measured at admission, third day and after one week. Average serum albumin on admission was 3.33 ± 0.44, after 3 days 2.85 ± 0.54 and after 1 week 2.46 ± 0.67 gm./dL, while hemoglobin concentration was 14.79 ± 2.13, 12.25 ± 1.99, and 10.24 ± 2.47 gm./dl respectively. However, base deficit was 5.75 ± 2.40, 5.24 ± 2.05 and 5.45 ± 2.76 respectively, with significant statistical difference (p<0.001) between the death and survivor groups. Binary logistic regression analysis for independent predictors of mortality declared that base deficit, albumin and hemoglobin serum levels were independent predictors for mortality with an odds ratio of 2.23, 95% CI, 1.66-16.75 for base deficit, 3.56, 95% CI, 1.88-12.59 for albumin and 2.21, 95% CI, 1.56-13.54 for hemoglobin. Hypoalbuminemia, anemia and excess base deficit can be used as prognostic factors for mortality in major burn patients.

L'hypoalbuminémie du brûlé est la conséquence d'un dysfonctionnement endothélial généralisé. Les pertes sanguines occasionnent une anémie. Il persiste une controverse quant à l'utilisation des colloïdes naturels chez ces patients : faut il les utiliser et, si oui, lesquels et quand ? Les buts de ce travail étaient d'étudier si les altérations des échanges gazeux, le déficit de base, l'hypoalbuminémie et l'anémie étaient corrélés à la mortalité, s'il fallait utiliser des colloïdes naturels et quand. Il s'agit d'une étude prospective réalisée sur 42 patients admis en réanimation du CTB du CHU de Menoufia. L'albuminémie, le taux d'hémoglobine, la gazométrie et le déficit de base étaient mesurés à l'entrée, J3 et J7. L'albuminémie moyenne était de 33,3 ± 4,4 g/L à l'entrée, 28,5 ± 5,4 g/L à J3 et 24,6 ± 6,7 à J7. L'hémoglobine était à 14,79 ± 2,13 g/dL à l'entrée ; 12,25 ± 1,99 à J3 et 12,04 ± 2,47 à J7. Le déficit de base était respectivement de 5,75 ± 2,4 ; 5,24 ± 2,05 et 5,45 ± 2,76, avec une différence significative (p<0,001) entre vivants et décédés. En régression logistique binaire, le déficit de base (OR 2,23 ; IC 95 1,66-16,75) ; l'albuminémie (OR 3,56 ; IC 95 1,88-12,59) et l'anémie (OR 2,21 ; IC 95 1,56-13,54) apparaissent comme des variables indépendantes de mortalité. Ces 3 paramètres peuvent donc être utilisés pour prédire la mortalité d'un brûlé grave.

Inhalation injury as a prognostic factor for mortality in burn patients.

Inhalation injury greatly increases the incidence of respiratory failure and acute respiratory distress syndrome. It is also the cause of most early deaths in burn victims. The aim of this research is to study the incidence, early diagnosis, complications, and management of inhalation injury and to discuss the relationship between inhalation injury and death in burn patients. The study included 130 burn patients (61 male and 69 female) with inhalation injury admitted to Menoufiya University Hospital Burn Center & Chest Department (Egypt) from January 2008 to January 2010. It was found that the presence of inhalation injury, increasing burn size, and advancing age were all associated with increased mortality (p < 0.01). The incidence of inhalation injury was 46.3% (the 130 patients came from a total number of 281 burn victims). The overall mortality rate among patients with inhalation injury was 41.5% (54/130) compared with 7.2% (11/151) among patients without inhalation injury. These statistics clearly indicate that inhalation injury was an important factor for predicting burn patient mortality. Approximately 80% of fire-related deaths are due not to the airway burn injury itself but to the inhalation of toxic products, especially carbon monoxide and hydrogen cyanide gases. Inhalation injury is generally caused by thermal burns, and is mostly confined to the upper airways. Major airway, pulmonary, and systemic complications occur after inhalation injury, and this increases the incidence of mortality among burn patients.