A Comparison of Survivors and Non-Survivors of Burn-Related Sepsis

Authors:
Diana Julia Tedesco, Fadi Khalaf, Marc Jeschke, Maria Fernanda Hutter, Zachary Ricciuti

Body of Abstract:
Background: Sepsis is the most critical complication in burn patients and the leading cause of death post-burn. Clinical characteristics that differentiate survivors and non-survivors have not been explored yet, highlighting the need for further investigation into factors driving mortality in this population. This study aims to undertake a comparative analysis of survivors and non-survivors among burn patients with sepsis to identify key demographic and clinical distinctions to improve our understanding of prognostic indicators in burn-related sepsis.
Methods: Patients (≥18 years) with thermal burn injuries ≥5% TBSA admitted to a provincial burn centre in Toronto, Canada, between 2006 and 2021, with a subsequent clinical diagnosis of sepsis during hospitalization, were included. Eligible patients were stratified based on outcome (survivors vs. non-survivors). Demographics, injury characteristics, mortality, pathogens, and complications were assessed.
Results: 240 patients, including 197 survivors and 43 non-survivors, were included in the analysis. Compared to survivors, non-survivors were older (62.6 (15.2) vs. 48.6 (16.7) years; p<0.05) and had a decreased proportion of males (58.1% vs. 75.6%; p<0.05). Interestingly, distributions of burn etiologies, TBSA, and inhalation injuries were similar between survivors and non-survivors. Survivors and non-survivors also differed in their comorbid conditions upon admission, with non-survivors presenting with an increased prevalence of respiratory disease (p<0.05), diabetes (p<0.05), and hypertension (p<0.05). During hospitalization, the median onset of sepsis occurred earlier in non-survivors at 8 days post-burn, compared to 10 days post-burn in survivors (p<0.05). Additionally, non-survivors experienced an increased incidence of acute kidney injury (p<0.001), acute respiratory distress syndrome (p<0.01), respiratory failure (p<0.01), and graft loss due to infection (p<0.05). Non-survivors experienced a median (IQR) survival after sepsis diagnosis of 11.5 days (5-29). Surprisingly, we observed a similar presence of pathogens among survivors and non-survivors, with the overall most common species being Enterococcus (20.0%), Enterobacter (15.8%), Staphylococcus (12.5%), Klebsiella (10.0%), and Pseudomonas (10.0%). Conclusion: These findings identify older age, female sex, and earlier sepsis onset as factors associated with mortality in burn patients with sepsis. Interestingly, pathogen identity did not influence sepsis outcomes, indicating that further investigation is needed into underlying immunometabolic responses contributing to mortality. Together, these findings identified prognostic factors for post-burn sepsis mortality, which can help guide the development of strategies to improve outcomes in burn patients with sepsis.