Trajectories in survivors and non-survivors differ in adult and older adult burn patients

Author(s):
Sarah Rehou; Carly Knuth; Marc Jeschke

Background:

Survival post-burn injury has improved over the past few decades. However, there are still a large proportion of patients that do not survive due to the complexity of the burn injury itself, pre-existing medical conditions, age, and complications.

Hypothesis:

The purpose of this study was to characterize the phases of inflammatory and metabolic trajectories in survivors and non-survivors and to compare these in adults and older adults.

Methods:

We included patients (aged ≥ 18 years) with a burn injury (≥ 10% TBSA) admitted to our burn centre between 2006 and 2020. Clinical outcomes, laboratory measures, and inflammatory biomarkers were compared among survivors (SV), non-survivors who died within four days (NS≤4), and non-survivors who died in five or more days (NS≥5) post-injury. These groups were also compared within age cohorts: adults aged ≤64 years and older adults aged ≥ 65 years. Measures were based on days post-injury: 0-1, 2-4, 5-10, 11-18, 19-28, ≥ 29 days.

Results:

We studied 872 patients, median age 49 (35-63) years and median 19% (13-34) TBSA burn for survivors (n=705; 81%), NS≤4 days (n=99; 11%), and NS ≥ 5 days (n=68; 8%). Demographics and injury characteristics were significantly different among SV and NS. Median age was 46 (33-59) years for SV, 62 (46-73) years for NS≤4, and 67 (54-76) years for NS≥5 (p<0.0001). Median % TBSA burn was 17 (13-26) for SV, 67 (43-88) for NS≤4, and 27 (18-44) for NS≥5 (p<0.0001). We saw evidence of organ dysfunction and a diminished inflammatory profile in older adult burn patients associated with adverse outcomes.

Conclusions:

Survivors and non-survivors express distinct biomarker profiles post-injury; these were profoundly different in adults and older adults. Elucidating the differences in trajectories among early and late non-survivors will allow for the prediction and identification of patients at risk of mortality – a crucial step for personalized burn care.