Influence of pre-existing medical condition and predicting value of modified Elixhauser comorbidity index on outcome of burn patients

Lam, N N; Duc, Ngo Minh; Hung, N T

doi:10.1016/j.burns.2019.08.004

Cited by 11 publications

(3 citation statements)

References 21 publications

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“…Burn-induced coagulopathy was significantly more prevalent in patients with hypertension and other unspecified disorders of the circulatory system when compared to patients without burn-induced coagulopathy. The impact of preexisting diseases such as cardiovascular, pulmonary, and renal disease make fluid resuscitation remarkably more complicated in the early stages of acute burn management [13]. Lab values of alanine aminotransferase and aspartate aminotransferase were considerably elevated in patients with burn-induced coagulopathy compared to only mild elevations in those without burninduced coagulopathy (p < .0001).…”

Section: Discussionmentioning

confidence: 99%

The Utilisation of INR to identify coagulopathy in burn patients

Wermine,

Song,

Gotewal

et al. 2024

PLoS ONE

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Studies conflict on the significance of burn-induced coagulopathy. We posit that burn-induced coagulopathy is associated with injury severity in burns. Our purpose was to characterize coagulopathy profiles in burns and determine relationships between % total burn surface area (TBSA) burned and coagulopathy using the International Normalized Ratio (INR). Burned patients with INR values were identified in the TriNetX database and analyzed by %TBSA burned. Patients with history of transfusions, chronic hepatic failure, and those on anticoagulant medications were excluded. Interquartile ranges for INR in the burned study population were 1.2 (1.0–1.4). An INR of ≥ 1.5 was used to represent those with burn-induced coagulopathy as it fell outside the 3rd quartile. The population was stratified into subgroups using INR levels <1.5 or ≥1.5 on the day of injury. Data are average ± SD analyzed using chi-square; p < .05 was considered significant. There were 7,364 burned patients identified with INR <1.5, and 635 had INR ≥1.5. Comparing TBSA burned groups, burn-induced coagulopathy significantly increased in those with ≥20% TBSA; p = .048 at 20–29% TBSA, p = .0005 at 30–39% TBSA, and p < .0001 for 40% TBSA and above. Age played a significant factor with average age for those with burn-induced coagulopathy 59 ± 21.5 years and 46 ± 21.8 for those without (p < .0001). After matching for age, TBSA, and demographics, the risk of 28 day-mortality was higher in those with burn-induced coagulopathy compared to those without (risk difference 20.9%, p < .0001) and the odd ratio with 95% CI is 4.45 (3.399–5.825). Investigation of conditions associated with burn-induced coagulopathy showed the effect of heart diseases to be significant; 53% of patients with burn-induced coagulopathy had hypertension (p < .0001). Burn-induced coagulopathy increases with %TBSA burned. The information gained firmly reflects a link between %TBSA and burn-induced coagulopathy, which could be useful in prognosis and treatment decisions.

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Section: Discussionmentioning

confidence: 99%

The Utilisation of INR to identify coagulopathy in burn patients

Wermine,

Song,

Gotewal

et al. 2024

PLoS ONE

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“…The Elixhauser comorbidity index (ECI) is a score of weighted sums of comorbid conditions, and it was developed to assess influence of comorbidities on the outcomes of patients. [ 6 , 7 ] In the ECI scoring system, a total 29 comorbid conditions were used to develop a weight for each patient. In our study, ECI was converted to 5 groups: ECI up to –1, ECI of 0, ECI of 1 to 5, ECI of 6 to 10, and ECI of 11 or higher.…”

Section: Methodsmentioning

confidence: 99%

The impact of bariatric surgery on in-patient clinical outcomes among patients with autoimmune hepatitis

et al. 2020

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Autoimmune hepatitis (AIH) is a form of liver inflammation in which immune cells target hepatocytes, inducing chronic inflammatory states. Bariatric surgery (BS) was shown to reduce inflammation in severely obese patients. We hypothesize that obese patients with AIH and BS have lower prevalence of liver-related complications and in-patient mortality compared to those without BS. The National Inpatient Sample from 2007 to 2013 was queried for hospitalizations of adults over 18 years of age with a diagnosis of AIH. Of those, hospitalizations with BS were selected as cases and those with morbid obesity as controls. Case-control 1:2 matching was done based on sex, age, race, and comorbidities. Primary outcomes were prevalence of liver-related complications and in-patient mortality. Independent risk factors of in-patient clinical outcomes were identified using multivariate regression analysis. From 137,834 hospitalizations with a diagnosis of AIH, 688 with BS were selected as cases, and 1295 were matched as controls. The prevalence of ascites was higher in the BS group compared to the control (odds ratio 1.73, 95% confidence interval (CI) 1.27–2.36). The prevalence of cirrhosis (36.8% vs 33.2%), portal hypertension (7.4% vs 10.0%), hepatic encephalopathy (10.6% vs 8.7%), and varices and variceal bleeding (3.9% vs 5.5%) was not statistically different from case controls, ( P > .05). BS was an independent risk factor for ascites (adjusted odds ratio (aOR) 1.87; 95% CI 1.36–2.56) and hepatic encephalopathy (aOR 1.42; 95% CI 1.03–1.97) but was an independent protective factor against in-patient mortality (aOR 0.21, 95% CI 0.08–0.55) once adjusted for age, sex, race, and comorbidities.

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“…Burn injury is a significant public health concern, with the World Health Organization estimating 180,000 burn related deaths globally [1]. Socioeconomic status and comorbidities are associated with increased mortality in external surface burn patients of all ages [2,3]; however, differences in the impact of demographics, including comorbidity burden, between pediatric and adult burn populations has not been adequately studied. We performed a retrospective analysis of inpatients with external surface burns comparing presentation, management, and outcomes between children and adults.…”

Section: Introductionmentioning

confidence: 99%

Adult Burn Inpatients Have Increased Burn Severity and Mortality Compared to Children in a Retrospective Analysis of the 2017 National Inpatient Sample 2017

Desai,

Desir,

Lipner

2023

Dermatol Pract Concept

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Introduction: Socioeconomic status and comorbidities are associated with increased mortality in external surface burn patients of all ages, however differences in the impact of demographics between pediatric and adult burn populations has not been adequately studied. Objective: The purpose of this article is to explore the presentation, management, and outcomes of external surface burns between different age groups. Methods: The 2017 National Inpatient Sample (NIS) was queried for patients with any diagnosis of external body surface burns. Demographics, comorbidities, complications, total charges, length of stay (LOS), number of procedures undergone (NPU), and time from admission to first procedure (TFP) were identified. Univariate and multivariable analyses were used to identify statistical associations with age. Results: 52,335 inpatients were identified with burns, with the majority male (63.6%) and adults (81.8%). Mean age was 50.5 (SE: 0.1) and 5.5 (SE: 0.1) years for adults and children, respectively. Adults had higher incidence of hypertensive disease (43.5% vs. 1.4%), diabetes mellitus (24.1% vs. 0.3%), and obesity (11.7% vs. 1.6%) than children (p<0.001). Adults vs. children had higher odds for mortality (OR 4.26, 95% CI 3.08–5.89), sepsis (OR 5.16, 95% CI 4.10–6.48), and pneumonia (OR 4.26, 95% CI 3.30–5.50). Conclusion: In a national cohort of inpatients with external surface burns, total charges, LOS, NPU, TFP, and odds for complications varied by age. Pediatric patients more often had lower household incomes; however, adults had significantly higher odds for mortality suggesting that age and comorbidity status are more impactful on burn outcomes than socioeconomic status.

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Influence of pre-existing medical condition and predicting value of modified Elixhauser comorbidity index on outcome of burn patients

Cited by 11 publications

References 21 publications

The Utilisation of INR to identify coagulopathy in burn patients

The Utilisation of INR to identify coagulopathy in burn patients

The impact of bariatric surgery on in-patient clinical outcomes among patients with autoimmune hepatitis

Adult Burn Inpatients Have Increased Burn Severity and Mortality Compared to Children in a Retrospective Analysis of the 2017 National Inpatient Sample 2017

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