Burn Sepsis Epidemiology and Outcomes in Adults and Older Adults: A Single-Centre Cohort Study

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

Body of Abstract:
Background: Sepsis stands as the leading cause of morbidity and mortality in adult and older adult burn patients. Despite its significant impact, the epidemiology of sepsis in burn patients remains poorly understood due to limited data from studies with small sample sizes and inconsistent diagnostic criteria. This large-scale cohort study aims to bridge these gaps by comprehensively investigating the incidence and outcomes of sepsis in adult and older adult burn patients to provide evidence to inform clinical practice and improve survival in this vulnerable population.
Methods: Patients (≥18 years) with thermal burn injuries ≥5% TBSA admitted to a provincial burn centre between 2006 and 2021 were included. Eligible patients were stratified by age into adults (18-59 years) and older adults (≥60 years) and subsequently by a clinical diagnosis of sepsis during hospitalization (sepsis vs. control). To assess the impact of sepsis onset on outcomes, patients with early (≤14 days) vs. late (>14 days) sepsis diagnoses were compared. Demographics, injury characteristics, mortality, pathogens, and complications were assessed.
Results: 1,404 patients, including 1,052 adults and 352 older adults, were included in the analysis. Compared to non-septic controls, adult burn patients with sepsis had a larger TBSA burn and increased mortality (2% vs. 8%; p<0.05) at 50 days post-burn. Most strikingly, adult patients with sepsis experienced an increased incidence of pneumonia (p<0.05), acute kidney injury (p<0.05), and wound infections (p<0.05). The median (IQR) onset of sepsis occurred at 10 (6-14) days post-burn, and sepsis was associated with a 12% decrease in risk of mortality for each additional day in its onset post-burn (p<0.05). Similar patterns were observed among older adults, with sepsis patients having a greater TBSA and four-fold increased mortality (9% vs. 37%; p<0.05) at 50 days post-burn compared to controls. Older adult sepsis patients also showed an increase in pneumonia (p<0.05) and acute kidney injury (p<0.05) but similar incidence in wound infection. The median sepsis onset occurred at 11 (IQR 6-17) days post-burn, and the odds of mortality decreased by 7% for each additional day of sepsis onset (p<0.05). Conclusion: This study highlights the significant burden of sepsis in adult and older adult burn patients, revealing its high incidence and severe impact on outcomes. Notably, sepsis onset early during hospitalization was identified as a key risk factor associated with reduced survival, underscoring the need for timely diagnosis and management. Ultimately, these findings emphasize the importance of enhancing the diagnostic precision of sepsis, especially in the early phase post-burn, to improve patient outcomes.