Quantifying the effects of wound healing risk and potential on clinical measurements and outcomes of severely burned patients: A data-driven approach

Liu, Nehemiah T.; Shingleton, Sarah K; Fenrich, Craig; Serio-Melvin, Maria; Christy, Robert J.; Salinas, José

doi:10.1016/j.burns.2019.11.017

Cited by 3 publications

(4 citation statements)

References 27 publications

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“…Also, a significantly lower activity of skin prolylhydroxylase as an index of collagen formation was found to be related to the high incidence of wound dehiscence in icteric patients (7,8). Liu et al reported a strong clinical association between high bilirubin levels and impaired wound healing in severely burned patients (6). We did not find any example in the literature on the use of the CytoSorb adsorber to improve wound or skin graft healing in cases of hyperbilirubinaemia.…”

Section: Discussionmentioning

confidence: 58%

“…Our rationale for using CytoSorb therapy was, in particular, based on experimental studies which showed a negative influence of bilirubin on fibroblast proliferation and collagen formation (1)(2)(3)(4)(5). It was also based on observations of previous authors that icteric patients after abdominal surgery and severely burned patients with hyperbilirubinaemia were at risk of wound healing impairment (6)(7)(8).…”

Section: Methodsmentioning

confidence: 99%

“…hyperbilirubinaemia and in cases of abdominal surgery were shown to be more common than in patients without liver dysfunction (6)(7)(8).…”

mentioning

confidence: 99%

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Technical Note: Novel Use of CytoSorb™ Haemadsorption to Provide Wound Healing Support in Case of Severe Burn Trauma via Reduction of Hyperbilirubinaemia

et al. 2021

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Hyperbilirubinaemia has been shown to compromise wound healing in severely burned patients. The therapy options for patients with impairment of wound healing and subsequent severe liver dysfunction are limited. A novel extracorporeal treatment, CytoSorb® (CytoSorbents Corp, USA), is a whole blood adsorber composed of highly biocompatible and porous polystyrene divinylbenzene copolymer beads covered in a polyvinylpyrrolidone coating. It is capable of extracting mainly hydrophobic middle-sized (up to 55 kDa) molecules from blood via size exclusion, including cytokines and bilirubin. We performed therapy with CytoSorb® on a severely burned (48% Total Body Surface Area-TBSA) patient with secondary sclerosing cholangitis (SCC) to promote the wound healing process by reducing bilirubin concentrations and to bridge the time to spontaneous liver regeneration or eventually to liver transplantation after two skin transplantations had failed to provide wound closure. In the first 6 days the cartridge was changed on a daily basis and later after every 2–4 days. The therapy with six adsorbers decreased a total bilirubin concentration from 14.02 to 4.29 mg/dl. By maintaining a stable bilirubin concentration under 5 mg/dl, debridement of abdomen and upper extremities with autologous skin grafting and, 4 weeks later, autologous skin grafting of the back from scrotum and lower extremities were performed successfully. After wound healing had been achieved, the CytoSorb therapy was discontinued after 57 days and 27 adsorber changes. CytoSorb therapy can be a promising support of wound and skin graft healing in patients with severe burns and liver dysfunction due to a significant reduction of total bilirubin concentration.

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Section: Discussionmentioning

confidence: 58%

Section: Methodsmentioning

confidence: 99%

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Technical Note: Novel Use of CytoSorb™ Haemadsorption to Provide Wound Healing Support in Case of Severe Burn Trauma via Reduction of Hyperbilirubinaemia

et al. 2021

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“…Extensive burns result in a long disease course, high infection risk, large number of procedures, and high risk of mortality. Because of factors such as blood loss from the trauma itself, multiple operations, gastrointestinal bleeding, and the decreased erythrocyte production associated with nutritional deficiencies and systemic inflammation, patients with extensive burns are susceptible to severe and prolonged anemia 1 – 3 . Red blood cell (RBC) transfusion is an indispensable treatment to correct anemia in extensive burn patients which can increase hemoglobin level and blood volume in the short term, thus improve oxygen extraction and stabilize the internal environment 4 , 5 .…”

Section: Introductionmentioning

confidence: 99%

Ultra-restrictive red blood cell transfusion strategies in extensively burned patients

Wang,

Zhu,

Duan

et al. 2024

Sci Rep

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In recent years, due to the shortage of blood products, some extensive burn patients were forced to adopt an “ultra-restrictive” transfusion strategy, in which the hemoglobin levels of RBC transfusion thresholds were < 7 g/dl or even < 6 g/dl. This study investigated the prognostic impacts of ultra-restrictive RBC transfusion in extensive burn patients. This retrospective multicenter cohort study recruited extensive burns (total body surface area ≥ 50%) from three hospitals in Eastern China between 1 January 2016 and 30 June 2022. Patients were divided into an ultra-restrictive transfusion group and a restrictive transfusion group depending on whether they received timely RBC transfusion at a hemoglobin level < 7 g/dl. 1:1 ratio propensity score matching (PSM) was performed to balance selection bias. Modified Poisson regression and linear regression were conducted for sensitive analysis. Subsequently, according to whether they received timely RBC transfusion at a hemoglobin level < 6 g/dl, patients in the ultra-restrictive transfusion group were divided into < 6 g/dl group and 6–7 g/dl group to further compare the prognostic outcomes. 271 eligible patients with extensive burns were included, of whom 107 patients were in the ultra-restrictive transfusion group and 164 patients were in the restrictive transfusion group. The ultra-restrictive transfusion group had a significantly lower RBC transfusion volume than the restrictive transfusion group (11.5 [5.5, 21.5] vs 17.3 [9.0, 32.5] units, p = 0.004). There were no significant differences between the two groups in terms of in-hospital mortality, risk of infection, hospital length of stay, and wound healing time after PSM or multivariate adjustment (p > 0.05). Among the ultra-restrictive transfusion group, patients with RBC transfusion threshold < 6 g/dl had a significantly higher hospital mortality than 6–7 g/dl (53.1% vs 21.3%, p = 0.001). For extensive burn patients, no significant adverse effects of ultra-restrictive RBC transfusion were found in this study. When the blood supply is tight, it is acceptable to adopt an RBC transfusion threshold of < 7 g/dL but not < 6 g/dL.

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Prognostic impact of ultra-restrictive RBC transfusion in extensive burn patients: a retrospective multicenter cohort study running headline: ultra-restrictive transfusion in burns

Wang,

Zhu,

Duan

et al. 2023

Preprint

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Background In recent years, due to the shortage of blood products, some extensive burn patients were forced to adopt an “ultra-restrictive” transfusion strategy, in which the hemoglobin levels of RBC transfusion thresholds were < 7g/dl or even < 6 g/dL. This study investigated the prognostic impacts of ultra-restrictive RBC transfusion in extensive burn patients. Material and methods This retrospective multicenter cohort study recruited extensive burns (total body surface area ≥ 50%) from three hospitals in Eastern China between 1 January 2016 and 30 June 2022. Patients were divided into an ultra-restrictive transfusion group and a restrictive transfusion group depending on whether they received timely RBC transfusion at a hemoglobin level < 7 g/dL. 1:1 ratio propensity score matching (PSM) was performed to balance selection bias. Modified Poisson regression and linear regression were conducted for sensitive analysis. Subsequently, according to whether they received timely RBC transfusion at a hemoglobin level < 6 g/dl, patients in the ultra-restrictive transfusion group were divided into < 6 g/dl group and ≥ 6 g/dl group to further compare the prognostic outcomes. Results 271 eligible patients with extensive burns were included, of whom 107 patients were in the ultra-restrictive transfusion group and 164 patients were in the restrictive transfusion group. The ultra-restrictive transfusion group had a significantly lower RBC transfusion volume than the restrictive transfusion group (11.5 [5.5, 21.5] vs 17.3 [9.0, 32.5] units, p = 0.004). There were no significant differences between the two groups in terms of in-hospital mortality, risk of infection, hospital length of stay, and wound healing time after PSM or multivariate adjustment (p > 0.05). Among the ultra-restrictive transfusion group, patients with RBC transfusion threshold < 6 g/dl had a significantly higher hospital mortality than ≥ 6 g/dl (53.1% vs 21.3%, p = 0.001). Conclusion For extensive burn patients, no significant adverse effects of ultra-restrictive RBC transfusion were found in this study. When the blood supply is tight, it is acceptable to adopt an RBC transfusion threshold of < 7 g/dL but not < 6g/dL.

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Quantifying the effects of wound healing risk and potential on clinical measurements and outcomes of severely burned patients: A data-driven approach

Cited by 3 publications

References 27 publications

Technical Note: Novel Use of CytoSorb™ Haemadsorption to Provide Wound Healing Support in Case of Severe Burn Trauma via Reduction of Hyperbilirubinaemia

Technical Note: Novel Use of CytoSorb™ Haemadsorption to Provide Wound Healing Support in Case of Severe Burn Trauma via Reduction of Hyperbilirubinaemia

Ultra-restrictive red blood cell transfusion strategies in extensively burned patients

Prognostic impact of ultra-restrictive RBC transfusion in extensive burn patients: a retrospective multicenter cohort study running headline: ultra-restrictive transfusion in burns

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