Pneumonia after Burns – Prevalence, Risk Factors and Effect on Outcomes

Authors:
Julia Kleinhapl, Lucineia Gainski Danielski, Juquan Song, Steven Wolf, Celeste Finnerty, John Ekale

Body of Abstract:
Introduction:
Burn patients are prone to acute complications affecting multiple organ systems and are at particularly high risk for infections such as pneumonia due to systemic inflammation, loss of the skin barrier, and prolonged hospitalization. Despite its clinical relevance, the true prevalence of pneumonia after burn injury, associated patient characteristics, and its effect on sepsis and mortality have not been comprehensively evaluated in large populations. Using the global TriNetX database, we aimed to assess these associations in a multi-institutional cohort.

Methods:
Burn patients of all ages and sexes were identified using ICD-10 codes T20-T25 and T30-T32. Patients were screened for any pneumonia diagnosis occurring within 6 months after burn. Burn patients who developed pneumonia were compared to those who did not for risk of sepsis and mortality. Cohorts were propensity-score matched for demographics and chronic respiratory conditions such as asthma, COPD and emphysema. Analyses were run using TriNetX analytical features with p<0.05 considered significant. Results: A total of 962,495 burn patients were identified, of whom 21,091 developed pneumonia within 6 months after burn (prevalence 2.19%). Patients with pneumonia were predominantly male (57.09%) and had a mean age of 57 ± 24 years; acute respiratory failure occurred in 52% of cases. Half of these patients had a chronic pulmonary disease, including COPD (33%), asthma (26%), or emphysema (14%). Among pneumonia cases, 40% had mild burns (<20% total body surface area (TBSA) burned), 20% had >20% TBSA involvement, and 40% lacked burn-severity coding. Those with pneumonia after burn were coded with smoke inhalation injury in 7% of cases, whereas 0% of the burn-without-pneumonia cohort had a documented inhalation injury. Pneumonia after burn was associated with a substantially increased risk of sepsis (5.14% vs. 0.34%, p<0.0001; RR 15.34, 95% CI 14.156-16.627) and markedly elevated mortality (12.98% vs. 0.73%, p<0.0001; RR 17.78, 95% CI 17.029-18.569). Conclusion: Although pneumonia after burn appears to be relatively uncommon in a large real-world database, its association with dramatically increased risks of sepsis and mortality highlights the need for early recognition and targeted management of this high-risk subgroup of burn patients.