Impact of Oxandrolone Treatment on Acute Outcomes After Severe Burn Injury

Abstract

Pharmacologic modulation of hypermetabolism clearly benefits children with major burns, however, its role in adult burns remains to be defined. Oxandrolone appears to be a promising anabolic agent although few outcome data are as yet available. We examined whether early oxandrolone treatment in severely burned adults was associated with improved outcomes during acute hospitalization. We evaluated for potential associations between oxandrolone treatment and outcomes in a large cohort of severely burned adults in the context of a multicenter observational study. Patients were dichotomized with respect to oxandrolone treatment, defined as administration within 7 days after admission, with duration of at least 7 days. Acute hospitalization outcomes were compared with univariate and multivariate analyses. One hundred seventeen patients were included in this analysis. Mean patient age was 42.6 years (range, 18–86); 77% were male, with an average TBSA of 44.1%. Baseline and injury characteristics were similar among treatment and nontreatment cohorts. Oxandrolone treatment (N =59) did not impact length of stay but was associated with a lower mortality rate (P = .01) by univariate analysis. Oxandrolone treatment was independently associated with higher survival by adjusted analyses (P = .02). Examination of early oxandrolone treatment in this cohort of severely burned adults suggests that this therapy is safe and may be associated with improved survival. Further studies are necessary to define the exact mechanisms by which oxandrolone is beneficial during inpatient treatment.

Burn wound healing and treatment: review and advancements

“…In addition to local injury at the site of burn, severe thermal injury over a large area of the skin, roughly 20 % total body surface area (TBSA) or greater, results in acute systemic responses collectively known as burn shock [11]. Burn shock is characterized by increased capillary permeability, increased hydrostatic pressure across the microvasculature, protein and fluid movement from the intravascular space into the interstitial space, increased systemic vascular resistance, reduced cardiac output, and hypovolemia requiring fluid resuscitation [12]. The edema that forms in the interstitial space forms rapidly in the first 8 h following burn injury, and continues to form more slowly for at least 18 h [13].…”

“…Volume requirements for resuscitation can be estimated by the total burn size and the patient’s weight (or body surface area). Additional factors influencing these needs include the presence or absence of inhalation injury, the extent of full-thickness burns, and the time since injury [12]. The actual fluid infusion rate is then titrated hourly, based on the adequacy of physiological responses, such as the urine output [14].…”

Therapeutic Approaches to Combatting Hypermetabolism in Severe Burn Injuries

“…Their results illustrated that survivors and non-survivors display significant differences in critical markers of inflammation and metabolism at each time point. Non-survivors had significantly higher serum levels of IL-6, IL-8, granulocyte colony-stimulating factor, monocyte chemoattractant protein-1, c-reactive protein, glucose, insulin, blood urea nitrogen, creatinine, and bilirubin [144]. Furthermore, non-survivors had a huge increase in hypermetabolic response that was associated with increases in organ dysfunction and sepsis in comparison to the survivors [144].…”

“…Non-survivors had significantly higher serum levels of IL-6, IL-8, granulocyte colony-stimulating factor, monocyte chemoattractant protein-1, c-reactive protein, glucose, insulin, blood urea nitrogen, creatinine, and bilirubin [144]. Furthermore, non-survivors had a huge increase in hypermetabolic response that was associated with increases in organ dysfunction and sepsis in comparison to the survivors [144]. Further research initiatives in the field of hypermetabolism post severe burn injury is warranted to find the optimal combination of pharmacological treatments, non pharmacological care and potential biomarkers to establish a highly personalized treatment plan for burn patients which reduce mortality, improve healing time and in turn lead to a high quality of life for such patients.…”

Hormone in der Intensivmedizin

“…Der Grad der Beeinträchtigung der gonadotropen Achse korreliert mit der Schwere der Erkrankung [26]. Erniedrigte Testosteron-Konzentrationen werden mit einer katabolen Stoffwechsellage und Wundheilungsstörungen in Verbindung gebracht, und Studien an Verbrennungspatienten mit dem anabolen Steroid Oxandrolon zeigten einen positiven Effekt auf Körpergewicht, Wundheilung und Mortalität [21].…”