Management of calciphylaxis in a burn center: A case series and review of the literature

Dado, David; Huang, Benjamin; Foster, Daniel; Nielsen, Jamison S.; Gurney, Jennifer M; Morrow, Benjamin D.; Sharma, Kumar; Chung, Kevin K.; Ainsworth, Craig

doi:10.1016/j.burns.2018.09.008

Cited by 9 publications

(7 citation statements)

References 25 publications

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“… 1 , 39 Wound debridement is the most important but controversial therapy and is used to remove eschar, bacterial biofilms and inflamed adipose tissue, while debridement tissue can also be used for pathological examination. 40 Sepsis was possibly related to it in our study, especially surgical debridement; thus, we recommend prioritising gentle non‐surgical debridement, combined with dressings and skin grafts to promote wound healing. 41 Characteristic pharmacotherapy of sodium thiosulfate (STS) had some successful outcomes on uremic calciphylaxis and its administration and dose are inherited in NRC while lacking high‐quality randomised controlled trials to support its optimal use and efficacy.…”

Section: Discussionmentioning

confidence: 75%

“…Other treatment measures need to be implemented in combination with actual situations, such as analgesia and anti‐infective treatment, HBOT for poor transcutaneous oxygen partial pressure and vasodilators to improve local blood obstruction 1,39 . Wound debridement is the most important but controversial therapy and is used to remove eschar, bacterial biofilms and inflamed adipose tissue, while debridement tissue can also be used for pathological examination 40 . Sepsis was possibly related to it in our study, especially surgical debridement; thus, we recommend prioritising gentle non‐surgical debridement, combined with dressings and skin grafts to promote wound healing 41 .…”

Section: Discussionmentioning

confidence: 99%

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Refractory wounds induced by normal‐renal calciphylaxis: An under‐recognised calcific arteriolopathy

Dang

Zha

et al. 2022

International Wound Journal

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Background Normal‐renal calciphylaxis (NRC) is a devastating calcific vasculopathy characterised by refractory wounds. It is more likely to be misdiagnosed because of the absence of renal insufficiency. Failure to effectively control may lead to rapid deterioration and ultimately death. However, current knowledge of it is still inadequate. Objectives To provide a relatively comprehensive review of NRC. Methods Nine electronic medical databases including PubMed, Web of Science, Embase, the Cochrane Library and so on were searched from inception to April 1, 2022. Articles in which calciphylaxis was diagnosed in patients with normal renal function were included. Results Totally 140 articles were retrieved with 187 patients (median age, 62 years [IQR, 49.63 ~ 75.70 years]; 83.42% female; 84.5% Caucasian). Vitamin K antagonism (43.32%) and diabetes (39.57%) accounted for most of the concomitant factors. Cutaneous presentations were the most common. Pathological confirmation was made in 97.86% of patients with an accuracy of 99.45%. Multidisciplinary therapeutic strategies were usually implemented while the final prognosis was not ideal, with a 6‐month mortality rate of 21.10% and a 1‐year mortality rate of 27.52%. Conclusion NRC is an under‐recognised disease caused by a variety of factors; meanwhile, multidisciplinary efforts are required to inform diagnostic and therapeutic decisions.

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Section: Discussionmentioning

confidence: 75%

Section: Discussionmentioning

confidence: 99%

Refractory wounds induced by normal‐renal calciphylaxis: An under‐recognised calcific arteriolopathy

Dang

Zha

et al. 2022

International Wound Journal

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“…Among the 5601 publications retrieved from the targeted databases, 19 retrospective cohort studies 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 (422 patients; mean age, 57 years; 37.3% male) met our eligibility criteria. Among the 422 patients with CKD experiencing calciphylaxis, 347 were dialysis-dependent.…”

Section: Resultsmentioning

confidence: 99%

Intravenous Sodium Thiosulphate for Calciphylaxis of Chronic Kidney Disease

et al. 2023

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ImportanceCalciphylaxis is a rare disease with high mortality mainly involving patients with chronic kidney disease (CKD). Sodium thiosulphate (STS) has been used as an off-label therapeutic in calciphylaxis, but there is a lack of clinical trials and studies that demonstrate its effect compared with those without STS treatment.ObjectiveTo perform a meta-analysis of the cohort studies that provided data comparing outcomes among patients with calciphylaxis treated with and without intravenous STS.Data SourcesPubMed, Embase, Cochrane Library, Web of Science, and ClinicalTrials.gov were searched using relevant terms and synonyms including sodium thiosulphate and calci* without language restriction.Study SelectionThe initial search was for cohort studies published before August 31, 2021, that included adult patients diagnosed with CKD experiencing calciphylaxis and could provide a comparison between patients treated with and without intravenous STS. Studies were excluded if they reported outcomes only from nonintravenous administration of STS or if the outcomes for CKD patients were not provided.Data Extraction and SynthesisRandom-effects models were performed. The Egger test was used to measure publication bias. Heterogeneity was assessed using the I2 test.Main Outcomes and MeasuresSkin lesion improvement and survival, synthesized as ratio data by a random-effects empirical Bayes model.ResultsAmong the 5601 publications retrieved from the targeted databases, 19 retrospective cohort studies including 422 patients (mean age, 57 years; 37.3% male) met the eligibility criteria. No difference was observed in skin lesion improvement (12 studies with 110 patients; risk ratio, 1.23; 95% CI, 0.85-1.78) between the STS and the comparator groups. No difference was noted for the risk of death (15 studies with 158 patients; risk ratio, 0.88; 95% CI, 0.70-1.10) and overall survival using time-to-event data (3 studies with 269 participants; hazard ratio, 0.82; 95% CI, 0.57-1.18). In meta-regression, lesion improvement associated with STS negatively correlated with publication year, implying that recent studies are more likely to report a null association compared with past studies (coefficient = −0.14; P = .008).Conclusions and RelevanceIntravenous STS was not associated with skin lesion improvement or survival benefit in patients with CKD experiencing calciphylaxis. Future investigations are warranted to examine the efficacy and safety of therapies for patients with calciphylaxis.

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“…Reducing muscle catabolism due to burns requires strict regulation of post-burn hypermetabolism. A larger burn wound area, the patient's increased weight, and a postponement of surgery all enhance the risk of muscle catabolism, as shown in the study by Hart et al Williams et al discovered that burn patients with elevated catecholamine production had significantly elevated heart rate, stroke volume, cardiac work, rate pressure product, myocardial oxygen consumption, and cardiac index, and that these abnormal values persisted for up to two years after the burn injury [77][78][79] .…”

Section: Burn Patients' Complications During the Process Of Healingmentioning

confidence: 99%

Burn Injury Management, Pathophysiology and Its Future Prospectives

Kumar¹,

Kumari

et al. 2022

J. Res. Appl. Sci. Biotechnol.

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For intensive care physicians, burns are a frequent and challenging patient complication. Specialist facilities prioritise patient stabilisation, infection prevention, and functional rehabilitation to the greatest extent possible. Researchers have been focusing on burns for decades, and thanks to their efforts, the mortality rate for burn patients, especially young patients and those with moderate burns, has been steadily declining. However, the intensivist often faces challenges that make it hard to provide care and stabilise patients. There may be unique complications associated with burn wounds that necessitate either delayed treatment or prolonged rehabilitation. Improvements in patient stabilisation and treatment have resulted from advances made in burn wound care thanks to research. This article discusses recent advances in the treatment of burn patients, focusing on the pathophysiology of burns and the management of burn wounds.

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Management of calciphylaxis in a burn center: A case series and review of the literature

Cited by 9 publications

References 25 publications

Refractory wounds induced by normal‐renal calciphylaxis: An under‐recognised calcific arteriolopathy

Refractory wounds induced by normal‐renal calciphylaxis: An under‐recognised calcific arteriolopathy

Intravenous Sodium Thiosulphate for Calciphylaxis of Chronic Kidney Disease

Burn Injury Management, Pathophysiology and Its Future Prospectives

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