Using competing risk and multistate model to estimate the impact of nosocomial infection on length of stay and mortality in burn patients in Southeast China

Abstract

ObjectiveDue to the defects in skin barrier function and immune response, burn patients who survive the acute phase of a burn injury are at a high risk of nosocomial infection (NI). The aim of this study is to evaluate the impacts of NI on length of stay (LOS) and hospital mortality in burn patients using a multistate model.Design and settingA retrospective observational study was conducted in burn unit and intensive care unit in the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.ParticipantsData were obtained from 1143 records of patients admitted with burn between 1 January 2013 and 31 December 2016.MethodsRisk factors for NIs were determined by binary logistic regression. The extended Cox model with time-varying covariates was used to determine the impact of NIs on hospital mortality, and cumulative incidence functions were calculated. Multiple linear regression analysis was applied to detect the variables associated with LOS. Using a multistate model, the extra LOS due to NI were determined.Results15.8% of total burn patients suffered from NIs and incidence density of NIs was 9.6 per 1000 patient-days. NIs significantly increased the rate of death (HR 4.266, 95% CI 2.218 to 8.208, p=0.000). The cumulative probability of death for patients with NI was greater that for those without NI. The extra LOS due to NIs was 17.68 days (95% CI 11.31 to 24.05).ConclusionsUsing appropriate statistical methods, the present study further illustrated that NIs were associated with the increased cumulative incidence of burn death and increased LOS in burn patients.

Utility of Systemic Inflammatory Syndrome Score in Predicting Healthcare-Associated Infections in Critically Ill Patients: A Matched Case-Control Study

“…Previous studies illustrated that SIRS induced by infectious diseases and non-infectious diseases share many features. Additionally, immune dysfunction and increased susceptibility to opportunistic infections were observed in the two types of SIRS [6,13,[20][21]. In the present study, we noticed that infectious SIRS was more effective than SIRS in predicting HAIs.…”

“…High incidence of HAIs has been observed in some single diseases mentioned above [6,13]. However, patients admitted with SIRS, as a special population of critically ill patients, have a higher susceptibility to HAIs or not remained to be investigated.…”

Association Between Perineal Burns Injury and In-hospital Mortality: A Retrospective Observational Study from the Nation-Wide Burn Registry in Japan

“…2 A perineal burn is easily contaminated with urine and stool, and is occasionally associated with multidrug-resistant bacterial infections that could lead to nosocomial infections, increased hospital mortality, and LOS among hospitalized burn patients. 1 Several limitations of our study should be acknowledged. First, it was a retrospective observational study based on registry data, and residual confounding and unmeasured outcome predictors could have had an impact (e.g., comorbidities, cumulative fluid balance, timing of surgery, and volume-outcome relationships).…”

“…Burns are a potentially lethal injury and a significant health concern worldwide. 1 Perineal burns are not frequent injuries. From the national burn repository in the United States, the incidence of perineal burns was 1.7% among hospitalized burn patients.…”

‘Poverty flames burns’: deficiencies of burn care financing in Iran’s healthcare system

“…Therefore, providing burn services is costly and reduces the hospitals ability to generate income surplus. A study on SBHs of Iran found that hospitalized patients experience high rates of hospital infections [35], that may prolong hospitalization period [36][37][38], rise healthcare costs, increase hospitalization period in intensive care units and using ventilator [37].…”