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Aschacher O, Pauzenberger R, Hacker S. Reply to Letter to the Editor on "Is diabetes mellitus an independent contributor towards burns mortality?". Burns 2024; 50:527-528. [PMID: 38065803 DOI: 10.1016/j.burns.2023.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 11/17/2023] [Indexed: 02/24/2024]
Affiliation(s)
- Olivia Aschacher
- Department of Emergency Medicine, Clinic Floridsdorf, Brünnerstrasse 68, 1210 Vienna, Austria
| | - Reinhard Pauzenberger
- Private Practice Dr. Reinhard Pauzenberger, Hauptstraße 7, 4861 Schörfling am Attersee, Austria
| | - Stefan Hacker
- Private Practice Dr. Stefan Hacker, Tulpengasse 2/2, 1080 Vienna, Austria.
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Aschacher O, Kaider A, Sternat N, Ederer IA, Stievano S, Radtke C, Hacker S, Pauzenberger R. Impact of diabetes on clinical outcome in severely burned patients. Burns 2023; 49:193-199. [PMID: 35260251 DOI: 10.1016/j.burns.2022.02.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 02/20/2022] [Accepted: 02/21/2022] [Indexed: 01/06/2023]
Abstract
INTRODUCTION According to the International Diabetes Federation, approximately 425 million people worldwide suffer from diabetes mellitus, a figure that will double in the next 20 years. Data on the ratio of treated diabetics in burn intensive care units remain scarce and the effects on the mortality rate are poorly defined. METHODS Our retrospective, single-centre study aimed to evaluate differences in the risk factors due to diabetes mellitus, the clinical outcome and the patient population of diabetic patients after severe burn injuries over a time period of 21 years. RESULTS Despite increasing numbers of diabetic patients, the ratio of burn patients suffering from diabetes remained stable during the study period. The risk factors for mortality were higher age (OR 1.03, 95% confidence interval (CI), 1.02-1.04, p < 0.0001), female sex (OR 1.56, 95% CI, 1.06-2.29, p = 0.025), higher % total body surface area (TBSA) (OR 3.88, 95% CI, 2.81-5.46, p < 0.0001), full thickness burns (OR 8.58, 95% CI, 3.84 - 23.60, p < 0.0001) and the presence of inhalation injuries (OR 4.68, 95% CI, 3.15-7.02, p < 0.0001) Patients with diabetes had a smaller extent of burned areas with a median TBSA of 30% (quartiles: 22-50%, p = 0.036) compared to non-diabetic patients (35% (25-55%)) but had a similar length of stay with a median of 29 (quartiles: 13-44) days vs. 23 (10-48) days. Outcome analysis showed an overall mortality of 35.6%. Diabetes was not associated with higher mortality rate after burn injury in a univariate model (OR 1.80, 95% CI 0.92-3.51). After correction for %TBSA, the effect of diabetes on mortality was significant (OR 2.80, 95% CI, 1.33-5.90). CONCLUSION Our data indicate higher mortality rates (50-100%) of diabetic patients with TBSA greater than 40% in severely burned patients compared to non-diabetic patients without a significant outcome due to the low number of cases in the subgroup analyses.
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Affiliation(s)
- Olivia Aschacher
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Alexandra Kaider
- Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria
| | - Nikolaus Sternat
- Department of Pediatrics, Landesklinikum Mistelbach-Gänserndorf, Liechtensteinstraße 67, 2130 Mistelbach, Austria
| | - Ines Ana Ederer
- Department of Plastic and Aesthetic, Reconstructive and Hand Surgery, Agaplesion Markus Hospital, Wilhelm-Epstein-Straße 4, 60431 Frankfurt/Main, Germany
| | - Simona Stievano
- Department of Hand Surgery, Rhön-Klinikum Campus Bad Neustadt, Von-Guttenmberg-Straße 11, 97616 Bad Neustadt an der Saale, Germany
| | - Christine Radtke
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Stefan Hacker
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria; Department of Plastic, Reconstructive and Aesthetic Surgery, Landesklinikum Wiener Neustadt, Corvinusring 3-5, 2700 Wiener Neustadt, Austria.
| | - Reinhard Pauzenberger
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
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Yazdi MK, Zare M, Khodadadi A, Seidi F, Sajadi SM, Zarrintaj P, Arefi A, Saeb MR, Mozafari M. Polydopamine Biomaterials for Skin Regeneration. ACS Biomater Sci Eng 2022; 8:2196-2219. [PMID: 35649119 DOI: 10.1021/acsbiomaterials.1c01436] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Designing biomaterials capable of biomimicking wound healing and skin regeneration has been receiving increasing attention recently. Some biopolymers behave similarly to the extracellular matrix (ECM), supporting biointerfacial adhesion and intrinsic cellular interactions. Polydopamine (PDA) is a natural bioadhesive and bioactive polymer that endows high chemical versatility, making it an exciting candidate for a wide range of biomedical applications. Moreover, biomaterials based on PDA and its derivatives have near-infrared (NIR) absorption, excellent biocompatibility, intrinsic antioxidative activity, antibacterial activity, and cell affinity. PDA can regulate cell behavior by controlling signal transduction pathways. It governs the focal adhesion behavior of cells at the biomaterials interface. These features make melanin-like PDA a fascinating biomaterial for wound healing and skin regeneration. This paper overviews PDA-based biomaterials' synthesis, properties, and interactions with biological entities. Furthermore, the utilization of PDA nano- and microstructures as a constituent of wound-dressing formulations is highlighted.
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Affiliation(s)
- Mohsen Khodadadi Yazdi
- Jiangsu Co-Innovation Center of Efficient Processing and Utilization of Forest Resources and Joint International Research Lab of Lignocellulosic Functional Materials, Nanjing Forestry University, Nanjing 210037, China
| | - Mehrak Zare
- Skin and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran 141663-4793, Iran
| | - Ali Khodadadi
- Department of Internal Medicine, School of Medicine, Gonabad University of Medical Sciences, Gonabad 96914, Iran
| | - Farzad Seidi
- Jiangsu Co-Innovation Center of Efficient Processing and Utilization of Forest Resources and Joint International Research Lab of Lignocellulosic Functional Materials, Nanjing Forestry University, Nanjing 210037, China
| | - S Mohammad Sajadi
- Department of Nutrition, Cihan University─Erbil, Erbil, Kurdistan Region 44001, Iraq.,Department of Phytochemistry, SRC, Soran University, Soran, Kurdistan Regional Government 44008, Iraq
| | - Payam Zarrintaj
- School of Chemical Engineering, Oklahoma State University, 420 Engineering North, Stillwater, Oklahoma 74078, United States
| | - Ahmad Arefi
- Department of Chemical Engineering, McMaster University, Hamilton, Ontario L8S 4L8, Canada
| | - Mohammad Reza Saeb
- Department of Polymer Technology, Faculty of Chemistry, Gdańsk University of Technology, Narutowicza 11/12, Gdańsk 80-233, Poland
| | - Masoud Mozafari
- Department of Tissue Engineering & Regenerative Medicine, Iran University of Medical Sciences,Tehran 144961-4535, Iran
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Born LJ, Quiroga LH, Lagziel T, Hultman CS, Asif M. Clinical outcomes in 'diabese' burn patients: A systematic review and meta-analysis. Burns 2022; 48:281-292. [PMID: 34782233 DOI: 10.1016/j.burns.2021.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 03/09/2021] [Accepted: 04/06/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The objective of this study was to update the current status of clinical outcomes in diabetic (type II) and obese (BMI: 30-39.9 kg/m2) burn patients. METHODS We adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. We searched MEDLINE (PubMed), Google Scholar, Scopus, and Embase for studies related to a number of comorbidities and burn outcomes. Search terms for each of these databases are listed in the Appendix. From this search, we screened 6923 articles. Through our selection criteria, 12 articles focusing on either diabetes or obesity were selected for systematic review and meta-analysis. Data was analyzed using the "meta" package in R software to produce pooled odds ratios from the random effect model. RESULTS Diabetic patients had 2.38 times higher odds of mortality [OR: 2.38, 95% CI:1.66, 3.41], however no statistically significant difference was found in mortality in obese patients [OR: 2.49, 95% CI: 0.36, 17.19]. Obese patients had 2.18 times higher odds of inhalation injury [95%CI: 1.23, 3.88], whereas diabetic patients did not show a difference in odds of inhalation injury [OR:1.02, 95% CI: 0.57, 1.81]. Diabetic patients had higher odds of complications resulting from infection: 5.47 times higher odds of wound, skin, or soft tissue infections [95% CI:1.97, 15.18]; 2.28 times higher odds of UTI or CAUTI [95% CI:1.50, 3.46]; and 1.78 times higher odds of pneumonia or respiratory tract infections [95% CI:1.15, 2.77]. Obese patients also had similar complications related to infection: 2.15 times higher odds of wound infection [95% CI: 1.04, 4.42] and 1.96 times higher odds of pneumonia [95% CI: 1.08, 3.56]. Other notable complications in diabetic patients were higher odds of amputation [OR: 37, 95% CI: 1.76, 779.34], respiratory failure [OR: 4.39, 95% CI: 1.85, 10.42], heart failure [OR: 6.22, 95% CI: 1.93, 20.06], and renal failure [OR: 2.95, 95% CI: 1.1, 7.86]. CONCLUSIONS Diabetic patients have higher odds of mortality, whereas no statistically significant difference of mortality was found in obese patients. Obese patients had higher odds of inhalation injury, whereas odds of inhalation injury was unchanged in diabetic patients. Diabetic patients had higher odds of failure in multiple organs, whereas such failure in obese patients was not reported. Both diabetic and obese patients had multiple complications related to infection.
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Affiliation(s)
- Louis J Born
- Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD; Fischell Department of Bioengineering, University of Maryland, College Park, MD
| | - Luis H Quiroga
- Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Tomer Lagziel
- Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD; Sackler Faculty of Medicine, Tel-Aviv University, Israel
| | - C Scott Hultman
- Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Mohammed Asif
- Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD.
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Chang WY, Liu HH, Huang DW, Chou YY, Ou KL, Wang CH, Dai NT, Tzeng YS. Severe burn injury from the common Asian practice of heat application in patients with diabetic neuropathy. Int Wound J 2021; 19:845-852. [PMID: 34448552 PMCID: PMC9013579 DOI: 10.1111/iwj.13682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 08/18/2021] [Indexed: 11/29/2022] Open
Abstract
This was the first study to analyse patients who sustained severe self-induced burns from this common Asian practice. There is a need to raise public awareness and physician attention about the consequences of preventable burn injuries and the importance of first aid in patients with diabetic neuropathy. Retrospective data on 16 consecutive patients who had diabetes and neuropathy admitted to the plastic surgery ward at the Tri-Service General Hospital from January 1, 2015, to February 2, 2021 with burn injuries because of heat applications were collected and analysed for this study. Age, gender, season, first aid adequacy, comorbidity, interventions, total body surface area (TBSA), degree of burn, aetiology, length of stay (LOS), and status at discharge were reviewed. The mean age of the 16 patients was 65.13 years. The most common burn aetiology was contact (50%), followed by scald (37.5%) and radiation burns (12.5%). TBSA burn averaged ± standard deviation 1.54 ± 1.22. Seven patients (44%) had wound infections, and three patients underwent amputations. The average LOS was 28.2 days. Asian practice of heat application is the common aetiology of severe and preventable burn injuries. Education about neuropathy and the consequences of a burn injury should be provided to patients with diabetes.
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Affiliation(s)
- Wen-Yuan Chang
- Division of Plastic Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Hung-Hui Liu
- Division of Plastic Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Dun-Wei Huang
- Division of Plastic Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Yu-Yu Chou
- Division of Plastic Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Kuang-Ling Ou
- Division of Plastic Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chih-Hsin Wang
- Division of Plastic Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Niann-Tzyy Dai
- Division of Plastic Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Yuan-Sheng Tzeng
- Division of Plastic Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
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Rotman S, Lapaine P, Rehou S, Jeschke MG, Shahrokhi S. Comparison of clinical outcomes of lower extremity burns in diabetic and non-diabetic patients: a retrospective analysis. J Burn Care Res 2021; 43:93-97. [PMID: 34329452 DOI: 10.1093/jbcr/irab150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Diabetes mellitus is an increasingly prevalent chronic disease that leads to long-term health consequences. Some long-term clinical sequelae of diabetes include coronary artery disease, peripheral vascular disease, peripheral neuropathy, and impaired wound healing. These can increase hospital stay and complications such as wound infections and amputations among patients with lower extremity burns. A retrospective analysis was performed of all isolated lower extremity burns from a single tertiary burn care centre from 2006-2017. Patients were stratified by diabetic status and the incidence of lower extremity amputations was the primary outcome. Multivariable regression was used to model the association between diabetes and amputations, adjusting for patient and injury characteristics. A total of 198 patients were identified as meeting inclusion criteria, 160 were non-diabetic and 38 were diabetic. Age was significantly different between non-diabetic and diabetic patients; mean age was 46 ± 18 years versus 62 ± 17 years (p<0.0001). Length of stay was also significantly different, median length of stay was 11 (IQR 7-15) versus 18 (IQR 12-24) (p<0.001), with diabetic patients staying longer. There was a significantly greater proportion of diabetic patients that had an amputation (control 4% versus diabetic 29%; p<0.0001). After adjustment for patient and injury characteristics, there was a significant association between diabetes and amputation (p=0.002). Among patients with isolated lower extremity burns, those with a pre-existing condition of diabetes had a longer hospitalization and increased amputations, despite similar size of burn. Diabetes is an important risk factor to acknowledge in patients with these injuries to optimize care.
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Affiliation(s)
- Sydney Rotman
- Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Pierre Lapaine
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sarah Rehou
- Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Marc G Jeschke
- Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Sunnybrook Research Institute, Toronto, Ontario, Canada.,Division of Plastic and Reconstructive Surgery, Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Immunology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Shahriar Shahrokhi
- Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Division of Plastic and Reconstructive Surgery, Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Li C, Chen Z, Gao B, Yang M, Ren L, Li J, Zhang Y, Yang M. The effect of nursing intervention based on the staged behaviour change on recovery, quality of life, and self-efficacy of diabetic patients with scalds. Int Wound J 2021; 19:202-210. [PMID: 34080304 PMCID: PMC8684861 DOI: 10.1111/iwj.13622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 05/07/2021] [Accepted: 05/12/2021] [Indexed: 11/30/2022] Open
Abstract
This study aimed to explore the impact of nursing intervention based on staged behaviour change (SBC) on the quality of life (QoL) and self‐efficacy of diabetic patients with scalds. From January 2020 to January 2021, a total of 82 consecutive cases with diabetes and scalds were prospectively enrolled in this study. They were divided into the SBC group (41 cases were given SBC‐based nursing intervention) and the control group (41 cases were given routine intervention) using the random number table method. The granulation tissue growth time and wound healing time were compared between the two groups. Pain intensity, QoL, self‐efficacy, and score of wound exudation at 3, 7, and 15 days after intervention were observed. The granulation tissue growth time and wound healing time of the SBC group were lower than those of the control group with statistical difference (P < 0.05). The 3‐, 5‐, and 7‐day pain intensity of the SBC group were all lower than those of the control group, with statistical difference (P < 0.05, respectively). Before intervention, there were no significant differences in mental health, role emotional, social function, vitality status, physical pain, role physical, physical function, and general health between the two groups (P > 0.05, respectively). After intervention, the above indicators of the SBC group were significantly higher than those of the control group (P < 0.05, respectively). Before intervention, there were no significant differences between the two groups in communication with doctors, emotional communication, role function, symptom management, medication as prescribed, and control of water and salt intake and nutrition (P > 0.05, respectively). After intervention, the above indicators in the SBC group were all significantly higher than those in the control group (P < 0.05, respectively). The score of wound exudation of the SBC group was lower than that of the control group after intervention (P < 0.05). SBC‐based nursing intervention can effectively improve the QoL and self‐efficacy of diabetic patients with scalds and can effectively promote wound healing, and can be recommended for clinical use.
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Affiliation(s)
- Cuikun Li
- Department of Burn and Plastic Surgery, the First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Zhihua Chen
- Department of Endocrinology, the First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Bingquan Gao
- Department of Burn and Plastic Surgery, the First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Mingming Yang
- Department of Burn and Plastic Surgery, the First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Liqing Ren
- Department of Burn and Plastic Surgery, the First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Juan Li
- Department of Burn and Plastic Surgery, the First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Yulan Zhang
- Department of Burn and Plastic Surgery, the First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Meng Yang
- Department of Burn and Plastic Surgery, the First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
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Akinosoglou K, Kapsokosta G, Mouktaroudi M, Rovina N, Kaldis V, Stefos A, Kontogiorgi M, Giamarellos-Bourboulis E, Gogos C. Diabetes on sepsis outcomes in non-ICU patients: A cohort study and review of the literature. J Diabetes Complications 2021; 35:107765. [PMID: 33187869 DOI: 10.1016/j.jdiacomp.2020.107765] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 06/17/2020] [Accepted: 09/14/2020] [Indexed: 01/12/2023]
Abstract
AIMS We sought to determine whether primary outcomes differ between non-ICU septic patients with and without type 2 diabetes (T2D). METHODS This study utilized the Hellenic Sepsis Study Group Registry, collecting nationwide data for sepsis patients since 2006, and classified patients upon presence or absence of T2D. Patients were perfectly matched for a) Sepsis 3 definition criteria (including septic shock) b) gender, c) age, d) APACHE II score and e) Charlson's comorbidity index (CCI). Independent sample t-test and chi-square t-test was used to compare prognostic indices and primary outcomes. RESULTS Of 4320 initially included non-ICU sepsis patients, 812 were finally analysed, following match on criteria. Baseline characteristics were age 76 [±10.3] years, 46% male, APACHE II 15.5 [±6], CCI 5.1 [±1.8], 24% infection, 63.8% sepsis and 12.2% septic shock. No significant difference was noted between two groups in qSOFA, SOFA, or suPAR1 levels (p = 0.7, 0.1 & 0.3) respectively. Primary sepsis syndrome resolved in 70.9% of cases (p = 0.9), while mortality was 24% in 28-days time. Cause of death was similar between patients with and without T2D (sepsis 17.8% vs 15.8%, heart event 3.7% vs 3.2%, CNS event 0.5% vs 0.5%, malignancy 0.7% vs 2% respectively, p = 0.6). CONCLUSIONS DM does not appear to negatively affect outcomes in septic patients not requiring ICU.
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Affiliation(s)
- Karolina Akinosoglou
- Dept of Internal Medicine and Infectious Diseases, University Hospital of Patras, Greece.
| | | | - Maria Mouktaroudi
- 4th Dept of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Greece
| | - Nikoletta Rovina
- 1st Dept of Pulmonary Medicine and Intensive Care Unit, National and Kapodistrian University of Athens, Medical School, Greece
| | | | - Aggelos Stefos
- Dept of Internal Medicine, Larissa University General Hospital, University of Thessaly, Greece
| | - Marina Kontogiorgi
- 2nd Dept of Critical Care Medicine, National and Kapodistrian University of Athens, Medical School, Greece
| | | | - Charalambos Gogos
- Dept of Internal Medicine and Infectious Diseases, University Hospital of Patras, Greece
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9
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Clinical outcomes following burn injury across the continuum of chronic glycemic control. Burns 2020; 47:1059-1065. [PMID: 33288330 DOI: 10.1016/j.burns.2020.10.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 10/12/2020] [Accepted: 10/19/2020] [Indexed: 11/23/2022]
Abstract
Diabetes has been associated with poor outcomes following burn injury. There is limited data related to prediabetes in burn injury, and no studies to date have compared clinical outcomes inpatients without diabetes, with prediabetes, and with diabetes. Therefore, this study aimed to compare clinical outcomes after burn injury across the continuum of pre-injury glucose control. A propensity score weighted cohort study of adult patients admitted for initial management of burn injury was performed. Patients were categorized as no diabetes, prediabetes or diabetes based on their admission hemoglobin A1c and past medical history. The primary outcome was length of stay per percent Total Body Surface Area (TBSA) burn. Secondary outcome measures included length of stay, all-cause hospital mortality, disposition at discharge, re-grafting of same site, and amputations. A total of 2450 patients were screened; 1137 patients were included for evaluation (236 diabetes, 191 prediabetes, 710 no diabetes). After inverse probability weighing to adjust for potentially confounding factors, patients in the diabetes group had longer length of stay/%TBSA burn than both the no diabetes group (ratio of geometric means (95% CI) = 1.65 (1.25, 2.18), p < 0.001) and the prediabetes group (ratio (95% CI) = 1.49 (1.10, 2.02), p = 0.01). No statistically significant differences in secondary outcomes were observed between groups other than a higher rate of amputations in the diabetes group (2.7%) compared to the no diabetes (0.7%, p = 0.047) and prediabetes (0%, p = 0.04) groups. Further studies are needed to delineate the differences across the continuum of pre-injury glucose control in order to identify mechanisms to optimize burn-related outcomes.
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Diab J, O'Hara J, Pye M, Parker C, Maitz PKM, Issler-Fisher A. Foot burns: A comparative analysis of diabetic and non-diabetic patients. Burns 2020; 47:705-713. [PMID: 32863067 DOI: 10.1016/j.burns.2020.07.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 07/28/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Foot burns represent a small part of the body with many challenges. The impact of diabetes on clinical outcomes adds further issues in management that clinicians must consider in their management. These factors have serious implications on morbidity and long term sequelae. Our aim is to analyse epidemiological trends of foot burns and examine the differences between diabetic and non-diabetics at Concord hospital from 2014 to 2019. METHODS A retrospective audit from 2014-19 at Concord General Repatriation Hospital Burns Unit summarised patient demographics, burn injury, diabetic status, operations and length of stay. All foot burn injuries from 2014-19 of all ages and gender that attended Concord burns hospital were included in this study. RESULTS We treated 797 patients who presented with foot burns, of which 16.2% were diabetic. The average age was higher in diabetics (60.72 years) than non-diabetics (39.72 years) and more males suffered burns compared to females in both groups (p < 0.001). There was a larger portion of elderly patients (greater than 65 years old, 15.1% of total) who sustained foot burns in the diabetic group compared to the non-diabetic group (p < 0.001). The most affected season was summer (27.0%), but diabetic patients were 1.7 times more likely to sustain injury in winter than non-diabetics. Diabetics were 3.8 times more likely to have contact burns compared to non-diabetic patients (p < 0.001). In a multivariable linear regression analysis, factors that contributed to increased length of stay included elderly status, place of event, diabetic status, number of operations, ICU admission, wound infection, amputation, and admission [F (16, 757 = 41.149, p < 0.001, R2 = 0.465]. CONCLUSIONS With the increase of diabetes, our multidisciplinary approach to diabetic foot care should include nursing, medical and surgical disciplines to identify patients at risk. The data highlights that a focus on prevention and education for diabetes is central to optimize glycaemic control and burn management, whilst providing a multidisciplinary network on discharge.
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Affiliation(s)
- Jason Diab
- Concord Repatriation General Hospital, Burns Unit, Australia; Concord Clinical School, University of Sydney, Sydney, Australia; School of Medicine, University of Notre Dame, Sydney, Australia.
| | - Justine O'Hara
- Concord Repatriation General Hospital, Burns Unit, Australia; Concord Clinical School, University of Sydney, Sydney, Australia
| | - Miranda Pye
- Concord Repatriation General Hospital, Burns Unit, Australia
| | | | - Peter K M Maitz
- Concord Repatriation General Hospital, Burns Unit, Australia; ANZAC Research Institute, Concord Repatriation General Hospital, Sydney, Australia; Concord Clinical School, University of Sydney, Sydney, Australia
| | - Andrea Issler-Fisher
- Concord Repatriation General Hospital, Burns Unit, Australia; ANZAC Research Institute, Concord Repatriation General Hospital, Sydney, Australia; Concord Clinical School, University of Sydney, Sydney, Australia
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11
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Nizamani R, Heisler S, Chrisco L, Campbell H, Jones SW, Williams FN. Osteomyelitis Increases the Rate of Amputation in Patients With Type 2 Diabetes and Lower Extremity Burns. J Burn Care Res 2020; 41:981-985. [DOI: 10.1093/jbcr/iraa106] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Abstract
In patients with diabetes mellitus (DM), amputation rates exceed 30% when lower extremity osteomyelitis is present. We sought to determine the rate of osteomyelitis and any subsequent amputation in our patients with DM and lower extremity burns. We performed a single-site, retrospective review at our burn center using the institutional burn center registry, linked to clinical and administrative data. Adults (≥18 years old) with DM admitted from January 1, 2014 to December 31, 2018 for isolated lower extremity burns were eligible for inclusion. We evaluated demographics, burn characteristics, comorbidities, presence of radiologically confirmed osteomyelitis, length of stay (LOS), inpatient hospitalization costs, and amputation rate at 3 months and 12 months after injury. We identified 103 patients with DM and isolated lower extremity burns. Of these, 88 patients did not have osteomyelitis, while 15 patients had radiologically confirmed osteomyelitis within 3 months of the burn injury. Compared to patients without osteomyelitis, patients with osteomyelitis had significantly increased LOS (average LOS 22.7 days vs 12.1 days, P = .0042), inpatient hospitalization costs (average $135,345 vs $62,237, P = .0008), amputation rate within 3 months (66.7% vs 5.70%, P < .00001), and amputation rate within 12 months (66.7% vs 9.1%, P < .0001). The two groups were otherwise similar in demographics, burn injury characteristics, access to healthcare, and preexisting comorbidities. Patients with DM and lower extremity burns incurred increased LOS, higher inpatient hospitalization costs, and increased amputation rates if radiologically confirmed osteomyelitis was present within 3 months of the burn injury.
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Affiliation(s)
- Rabia Nizamani
- Department of Surgery, University of North Carolina School of Medicine, Chapel Hill
- North Carolina Jaycee Burn Center, Chapel Hill
| | - Stephen Heisler
- Department of Surgery, University of North Carolina School of Medicine, Chapel Hill
| | - Lori Chrisco
- Department of Surgery, University of North Carolina School of Medicine, Chapel Hill
- North Carolina Jaycee Burn Center, Chapel Hill
| | - Harold Campbell
- Mountain Area Health Education Center, Asheville, North Carolina
| | - Samuel W Jones
- Department of Surgery, University of North Carolina School of Medicine, Chapel Hill
- North Carolina Jaycee Burn Center, Chapel Hill
| | - Felicia N Williams
- Department of Surgery, University of North Carolina School of Medicine, Chapel Hill
- North Carolina Jaycee Burn Center, Chapel Hill
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12
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Increased risk of blood transfusion in patients with diabetes mellitus sustaining non-major burn injury. Burns 2019; 46:888-896. [PMID: 31848083 DOI: 10.1016/j.burns.2019.10.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 09/01/2019] [Accepted: 10/20/2019] [Indexed: 01/22/2023]
Abstract
BACKGROUND Due to the increased mortality and morbidity associated with blood transfusion, identifying modifiable predictors of transfusion are vital to prevent or minimise blood use. We hypothesised that burn patients with diabetes mellitus were more likely to be prescribed a transfusion. These patients tend to have increased age, number of comorbidities, infection risk and need for surgery which are all factors reported previously to be associated with blood use. OBJECTIVE To determine whether patients with diabetes mellitus who have sustained a burn ≤20% total body surface area (TBSA) are at higher risk of receiving red blood cell transfusion compared to those without diabetes mellitus. METHOD This was a retrospective cohort study including patients admitted to the major Burns Unit in Western Australia for management of a burn injury. Only the first hospital admission between May 2008 to February 2017 were included. RESULTS Among 2101 patients with burn injuries ≤20% TBSA, 48 (2.3%) received packed red blood cells and 169 (8.0%) had diabetes. There were 13 (7.7%) diabetic patients that were transfused versus 35 (1.8%) non-diabetic patients. Patients with diabetes were 5.2 (p = 0.034) times more likely to receive packed red blood cells after adjusting for percentage TBSA, haemoglobin at admission or prior to transfusion, number of surgeries, total comorbid burden and incidence of infection. As percentage TBSA increases, the probability of packed red blood cell transfusion increases at a higher rate in DM patients. CONCLUSIONS This study showed that diabetic patients with burn injuries ≤20% TBSA have a higher probability of receiving packed red blood cell transfusion compared to patients without diabetes. This effect was compounded in burns with higher percentage TBSA.
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Azevedo FF, Moreira GV, Teixeira CJ, Pessoa AFM, Alves MJ, Liberti EA, Carvalho CRO, Araújo EP, Saad MJA, Lima MHM. Topical Insulin Modulates Inflammatory and Proliferative Phases of Burn-Wound Healing in Diabetes-Induced Rats. Biol Res Nurs 2019; 21:473-484. [PMID: 31337227 DOI: 10.1177/1099800419864443] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The healing time of burn wounds depends on surface area and depth of the burn and associated comorbidities. Diabetes mellitus (DM) causes delays in the healing process by extending the inflammatory phase. Treatment with topical insulin can improve the inflammatory phase, restore metabolic dysregulation, and modulate impaired cellular signaling in burn wounds. The objective of this study was to evaluate markers of the inflammatory and proliferative phases of second-degree burns after topical insulin treatment in diabetic rats. Type I DM was induced with streptozotocin in male Wistar rats. The animals' backs were shaved and subjected to thermal burning. Rats were randomized into two groups: control diabetic (DC) and insulin diabetic (DI). At Days 7 and 14 postburn, rats were euthanized, and wound-tissue sections were evaluated by hematoxylin and eosin, Weigert, and Verhöeff staining, immunohistochemistry-paraffin, and enzyme-linked immunosorbent assay. A significant increase in reepithelialization was seen on Days 7 and 14 in DI versus DC rats. On Day 7, interleukin (IL)-1β, IL-6, monocyte chemotactic protein (MCP)-1, and F4/80 expression were increased in DI versus DC rats. On Day 14, MCP-1 expression was decreased and F4/80 increased in DI versus DC rats. On Days 7 and 14, Ki-67, transforming growth factor-β1, vascular endothelial growth factor expression, and formation of elastic fibers were increased in DI versus DC rats. Topical insulin modulates burn-wound healing in diabetic animals by balancing inflammation and promoting angiogenesis and formation of elastic fibers.
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Affiliation(s)
| | - Gabriela Virgínia Moreira
- 2 Department of Physiology and Biophysiology, Institute of Biomedical Sciences, University of Sao Paulo, Sao Paulo, Brazil
| | - Caio Jordão Teixeira
- 3 Department of Pharmacology, Faculty of Medical Sciences, State University of Campinas, Campinas, Sao Paulo, Brazil
| | - Ana Flávia Marçal Pessoa
- 4 Department of Cell Biology and Development, Institute of Biomedical Sciences, University of Sao Paulo, Sao Paulo, Brazil
| | - Michele Joana Alves
- 4 Department of Cell Biology and Development, Institute of Biomedical Sciences, University of Sao Paulo, Sao Paulo, Brazil
| | - Edson Aparecido Liberti
- 5 Department of Anatomy, Institute of Biomedical Sciences, University of Sao Paulo, Sao Paulo, Brazil
| | | | | | - Mário José Abdala Saad
- 6 Department of Internal Medicine, Faculty of Medical Sciences, State University of Campinas, Campinas, Sao Paulo, Brazil
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14
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Dual Gene Expression Analysis Identifies Factors Associated with Staphylococcus aureus Virulence in Diabetic Mice. Infect Immun 2019; 87:IAI.00163-19. [PMID: 30833333 DOI: 10.1128/iai.00163-19] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 02/26/2019] [Indexed: 11/20/2022] Open
Abstract
Staphylococcus aureus is a major human pathogen of the skin. The global burden of diabetes is high, with S. aureus being a major complication of diabetic wound infections. We investigated how the diabetic environment influences S. aureus skin infection and observed an increased susceptibility to infection in mouse models of both type I and type II diabetes. A dual gene expression approach was taken to investigate transcriptional alterations in both the host and bacterium after infection. While analysis of the host response revealed only minor changes between infected control and diabetic mice, we observed that S. aureus isolated from diabetic mice had significant increases in the levels of genes associated with translation and posttranslational modification and chaperones and reductions in the levels of genes associated with amino acid transport and metabolism. One family of genes upregulated in S. aureus isolated from diabetic lesions encoded the Clp proteases, associated with the misfolded protein response. The Clp proteases were found to be partially glucose regulated as well as influencing the hemolytic activity of S. aureus Strains lacking the Clp proteases ClpX, ClpC, and ClpP were significantly attenuated in our animal model of skin infection, with significant reductions observed in dermonecrosis and bacterial burden. In particular, mutations in clpP and clpX were significantly attenuated and remained attenuated in both normal and diabetic mice. Our data suggest that the diabetic environment also causes changes to occur in invading pathogens, and one of these virulence determinants is the Clp protease system.
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15
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Rittenhouse BA, Rizzo JA, Shields BA, Rowan MP, Aden JK, Salinas J, Fenrich CA, Shingleton SK, Serio-Melvin M, Burmeister DM, Cancio LC. Predicting wound healing rates and survival with the use of automated serial evaluations of burn wounds. Burns 2018; 45:48-53. [PMID: 30473409 DOI: 10.1016/j.burns.2018.10.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 10/12/2018] [Accepted: 10/25/2018] [Indexed: 12/30/2022]
Abstract
Healing of burn wounds is necessary for survival; however tracking progression or healing of burns is an inexact science. Recently, the relationship of mortality and wound healing has been documented with a software termed WoundFlow. The objective of the current study was to confirm various factors that impact burn wound healing, as well as to establish a timeline and rate of successful healing. A retrospective analysis was performed on adults (n=115) with at least 20% TBSA burn that had at least two computer-based wound mappings. The % open wound (%OW) was calculated over time to document healing trajectory until successful healing or death. Only 2% of patients in the group with successful wound healing died. A decrease in the %OW of 0.8 (IQR: 0.7-1.1) was associated with survival. Disparities in wound healing trajectories between survivors and non-survivors were distinguishable by 2weeks post-injury (P<0.05). When %TBSA was stratified by decile, the 40-49% TBSA group had the highest healing rate. Taken together, the data indicate that wound healing trajectory (%OW) varies with injury severity and survival. As such, automated mapping of wound healing trajectory may provide valuable information concerning patient/prognosis, and may recommend early interventions to optimize wound healing.
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Affiliation(s)
- Bradley A Rittenhouse
- United States Army Institute of Surgical Research, Fort Sam Houston, TX, United States; Uniformed Services University of Health Sciences, Bethesda, MD, United States
| | - Julie A Rizzo
- United States Army Institute of Surgical Research, Fort Sam Houston, TX, United States; Uniformed Services University of Health Sciences, Bethesda, MD, United States.
| | - Beth A Shields
- United States Army Institute of Surgical Research, Fort Sam Houston, TX, United States
| | - Matthew P Rowan
- United States Army Institute of Surgical Research, Fort Sam Houston, TX, United States
| | - James K Aden
- Brooke Army Medical Center, Fort Sam Houston, TX, United States
| | - José Salinas
- United States Army Institute of Surgical Research, Fort Sam Houston, TX, United States
| | - Craig A Fenrich
- United States Army Institute of Surgical Research, Fort Sam Houston, TX, United States
| | - Sarah K Shingleton
- United States Army Institute of Surgical Research, Fort Sam Houston, TX, United States
| | - Maria Serio-Melvin
- United States Army Institute of Surgical Research, Fort Sam Houston, TX, United States
| | - David M Burmeister
- United States Army Institute of Surgical Research, Fort Sam Houston, TX, United States
| | - Leopoldo C Cancio
- United States Army Institute of Surgical Research, Fort Sam Houston, TX, United States
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16
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Farokhi M, Mottaghitalab F, Fatahi Y, Khademhosseini A, Kaplan DL. Overview of Silk Fibroin Use in Wound Dressings. Trends Biotechnol 2018; 36:907-922. [PMID: 29764691 DOI: 10.1016/j.tibtech.2018.04.004] [Citation(s) in RCA: 236] [Impact Index Per Article: 39.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 03/11/2018] [Accepted: 04/10/2018] [Indexed: 01/01/2023]
Abstract
Recently, biomimetic wound dressings were introduced as potential replacements for treating skin injuries. Although there are some clinically available skin replacements, the range of wound types and locations necessitates a broader range of options for the clinic. Natural polymeric-based dressings are of central interest in this area due to their outstanding biocompatibility, biodegradability, low toxicity, and non-allergenic nature. Among them, silk fibroin (SF) has exceptional characteristics as a wound dressing. SF-based dressings can also be used as carriers for delivering drugs, growth factors, and bioactive agents to the wound area, while providing appropriate support for complete healing. In this review, we describe recent advances in the development of SF-based wound dressings for skin regeneration.
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Affiliation(s)
- Mehdi Farokhi
- National Cell Bank of Iran, Pasteur Institute of Iran, Tehran, Iran.
| | - Fatemeh Mottaghitalab
- Nanotechnology Research Centre, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Yousef Fatahi
- Department of pharmaceutical nanotechnology, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Khademhosseini
- Department of Bioengineering, Department of Chemical and Biomolecular Engineering, Department of Radiology, California NanoSystems Institute, University of California-Los Angeles, Los Angeles, CA, USA
| | - David L Kaplan
- Department of Biomedical Engineering, Tufts University, Medford, MA, USA
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Valent F, Tonutti L, Grimaldi F. Does diabetes mellitus comorbidity affect in-hospital mortality and length of stay? Analysis of administrative data in an Italian Academic Hospital. Acta Diabetol 2017; 54:1081-1090. [PMID: 28916936 DOI: 10.1007/s00592-017-1050-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 09/07/2017] [Indexed: 12/18/2022]
Abstract
AIMS Hospitalized patients with comorbid diabetes mellitus may have worse outcomes than the others. We conducted a study to assess whether comorbid diabetes affects in-hospital mortality and length of stay. METHODS For this population-based study, we analyzed the administrative databases of the Regional Health Information System of the Region Friuli Venezia Giulia, where the Hospital of Udine is located. Hospital discharge data were linked at the individual patient level with the regional Diabetes Mellitus Registry to identify diabetic patients. For each 3-digit ICD-9-CM discharge diagnosis code, we assessed the difference in length of stay and in-hospital mortality between diabetic and non-diabetic patients. We conducted both univariate and multivariate analyses, adjusted for age, sex, Charlson's comorbidity score, and urgency of hospitalization, through linear and logistic regression models. RESULTS After adjusting for potential confounders, diabetes significantly increased the risk of in-hospital death among patients hospitalized for bacterial pneumonia (OR = 1.94) and intestinal obstruction (OR = 4.23) and length of stay among those admitted for several diagnoses, including acute myocardial infarction and acute renal failure. Admission glucose blood level was associated with in-hospital death in patients with pneumonia and intestinal obstruction, and increased length of stay for several conditions. CONCLUSIONS Patients with diabetes mellitus who are hospitalized for other health problems may have increased risk of in-hospital death and longer hospital stay. For this reason, diabetes should be promptly recognized upon admission and properly managed.
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Affiliation(s)
- Francesca Valent
- SOC Istituto di Igiene ed Epidemiologia Clinica, Azienda Sanitaria Universitaria Integrata di Udine, Via Colugna 50, 33100, Udine, Italy.
| | - Laura Tonutti
- Endocrinology, Diabetes, Metabolism and Clinical Nutrition, Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
| | - Franco Grimaldi
- Endocrinology, Diabetes, Metabolism and Clinical Nutrition, Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
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18
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Knowlin L, Strassle PD, Williams FN, Thompson R, Jones S, Weber DJ, van Duin D, Cairns BA, Charles A. Burn injury outcomes in patients with pre-existing diabetic mellitus: Risk of hospital-acquired infections and inpatient mortality. Burns 2017; 44:272-279. [PMID: 29029861 DOI: 10.1016/j.burns.2017.09.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 09/19/2017] [Accepted: 09/21/2017] [Indexed: 01/13/2023]
Abstract
BACKGROUND Diabetes mellitus (DM) is a major cause of illness and death in the United States, and diabetic patients are at increased risk for burn injury. We therefore sought to examine the impact of pre-existing DM on the risk of inpatient mortality and hospital acquired infections (HAI) among burn patients. METHODS Adult patients (≥18 years old) admitted from 2004 to 2013 were analyzed. Weighted Kaplan-Meier survival curves - adjusting for patient demographics, burn mechanism, presence of inhalation injury, total body surface area, additional comorbidities, and differential lengths of stay - were used to estimate the 30-day and 60-day risk of mortality and HAIs. RESULTS A total of 5539 adult patients were admitted and included in this study during the study period. 655 (11.8%) had a pre-existing DM. The crude incidence of HAIs and in-hospital mortality for the whole burn cohort was 8.5% (n=378) and 4.4% (n=243), respectively. Diabetic patients were more likely to be older, female, have additional comorbidities, inhalational injury, and contact burns. After adjusting for patient and burn characteristics, the 60-day risk of HAI among patients with DM was significantly higher, compared to non-diabetic patients (RR 2.07, 95% CI 1.28, 6.79). However, no significant difference was seen in the 60-day risk of mortality (RR 1.34, 95% CI 0.44, 3.10). CONCLUSIONS Pre-existing DM significantly increases the risk of developing an HAI in patients following burn injury, but does not significantly impact the risk of inpatient mortality. Further understanding of the immune modulatory mechanism of burn injury and DM is imperative to better attenuate the acquisition of HAIs.
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Affiliation(s)
- Laquanda Knowlin
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States; North Carolina Jaycee Burn Center, Chapel Hill, NC, United States
| | - Paula D Strassle
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States; Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Felicia N Williams
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States; North Carolina Jaycee Burn Center, Chapel Hill, NC, United States
| | - Richard Thompson
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States; North Carolina Jaycee Burn Center, Chapel Hill, NC, United States
| | - Samuel Jones
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States; North Carolina Jaycee Burn Center, Chapel Hill, NC, United States
| | - David J Weber
- Division of Adult Infectious Diseases, University of North Carolina, Chapel Hill, NC, United States
| | - David van Duin
- Division of Adult Infectious Diseases, University of North Carolina, Chapel Hill, NC, United States
| | - Bruce A Cairns
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States; North Carolina Jaycee Burn Center, Chapel Hill, NC, United States
| | - Anthony Charles
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States; North Carolina Jaycee Burn Center, Chapel Hill, NC, United States.
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19
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Sayampanathan AA. A difference in outcomes for diabetic patients with burns to their feet. Burns 2017; 43:1375-1376. [DOI: 10.1016/j.burns.2017.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 05/25/2017] [Indexed: 11/29/2022]
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20
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A difference in outcomes for diabetic patients with burns to their feet. Burns 2017; 43:1374-1375. [DOI: 10.1016/j.burns.2017.05.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 05/05/2017] [Indexed: 11/19/2022]
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