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Wang Y, Cai C, Zhu Z, Duan D, Xu W, Shen T, Wang X, Xu Q, Zhang H, Han C. Models predicting mortality risk of patients with burns to ≥ 50% of the total body surface. Burns 2024; 50:1277-1285. [PMID: 38490836 DOI: 10.1016/j.burns.2024.02.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 01/24/2024] [Accepted: 02/27/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND Several models predicting mortality risk of burn patients have been proposed. However, models that consider all such patients may not well predict the mortality of patients with extensive burns. METHOD This retrospective multicentre study recruited patients with extensive burns (≥ 50% of the total body surface area [TBSA]) treated in three hospitals of Eastern China from 1 January 2016 to 30 June 2022. The performances of six predictive models were assessed by drawing receiver operating characteristic (ROC) and calibration curves. Potential predictors were sought via "least absolute shrinkage and selection operator" regression. Multivariate logistic regression was employed to construct a predictive model for patients with burns to ≥ 50% of the TBSA. A nomogram was prepared and the performance thereof assessed by reference to the ROC, calibration, and decision curves. RESULT A total of 465 eligible patients with burns to ≥ 50% TBSA were included, of whom 139 (29.9%) died. The FLAMES model exhibited the largest area under the ROC curve (AUC) (0.875), followed by the models of Zhou et al. (0.853) and the ABSI model (0.802). The calibration curve of the Zhou et al. model fitted well; those of the other models significantly overestimated the mortality risk. The new nomogram includes four variables: age, the %TBSA burned, the area of full-thickness burns, and blood lactate. The AUCs (training set 0.889; internal validation set 0.934; external validation set 0.890) and calibration curves showed that the nomogram exhibited an excellent discriminative capacity and that the predictions were very accurate. CONCLUSION For patients with burns to ≥ 50%of the TBSA, the Zhou et al. and FLAMES models demonstrate relatively high predictive ability for mortality. The new nomogram is sensitive, specific, and accurate, and will aid rapid clinical decision-making.
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Affiliation(s)
- Yiran Wang
- Department of Burns & Wound Care Center, the Second Affiliated Hospital of Zhejiang University College of Medicine, Hangzhou, China; The Key Laboratory of the Diagnosis and Treatment of Severe Trauma and Burn of Zhejiang Province, Hangzhou, China; Center of Clinical Epidemiology & Biostatistics, Department of Scientific Research, the Second Affiliated Hospital of Zhejiang University College of Medicine, Hangzhou, China
| | - Chenghao Cai
- Department of Burns & Wound Care Center, the Second Affiliated Hospital of Zhejiang University College of Medicine, Hangzhou, China; The Key Laboratory of the Diagnosis and Treatment of Severe Trauma and Burn of Zhejiang Province, Hangzhou, China; Center of Clinical Epidemiology & Biostatistics, Department of Scientific Research, the Second Affiliated Hospital of Zhejiang University College of Medicine, Hangzhou, China
| | - Zhikang Zhu
- Department of Burns & Wound Care Center, the Second Affiliated Hospital of Zhejiang University College of Medicine, Hangzhou, China; The Key Laboratory of the Diagnosis and Treatment of Severe Trauma and Burn of Zhejiang Province, Hangzhou, China; Center of Clinical Epidemiology & Biostatistics, Department of Scientific Research, the Second Affiliated Hospital of Zhejiang University College of Medicine, Hangzhou, China
| | - Deqing Duan
- Department of Burns, the First Affiliated Hospital of Nanchang University, Nanchang, China; Center of Clinical Epidemiology & Biostatistics, Department of Scientific Research, the Second Affiliated Hospital of Zhejiang University College of Medicine, Hangzhou, China
| | - Wanting Xu
- Department of Burn Injury, the First Affiliated Hospital of Anhui Medical University, Hefei, China; Center of Clinical Epidemiology & Biostatistics, Department of Scientific Research, the Second Affiliated Hospital of Zhejiang University College of Medicine, Hangzhou, China
| | - Tao Shen
- Department of Burns & Wound Care Center, the Second Affiliated Hospital of Zhejiang University College of Medicine, Hangzhou, China; Center of Clinical Epidemiology & Biostatistics, Department of Scientific Research, the Second Affiliated Hospital of Zhejiang University College of Medicine, Hangzhou, China
| | - Xingang Wang
- Department of Burns & Wound Care Center, the Second Affiliated Hospital of Zhejiang University College of Medicine, Hangzhou, China; The Key Laboratory of the Diagnosis and Treatment of Severe Trauma and Burn of Zhejiang Province, Hangzhou, China; Center of Clinical Epidemiology & Biostatistics, Department of Scientific Research, the Second Affiliated Hospital of Zhejiang University College of Medicine, Hangzhou, China.
| | - Qinglian Xu
- Department of Burn Injury, the First Affiliated Hospital of Anhui Medical University, Hefei, China; Center of Clinical Epidemiology & Biostatistics, Department of Scientific Research, the Second Affiliated Hospital of Zhejiang University College of Medicine, Hangzhou, China.
| | - Hongyan Zhang
- Department of Burns, the First Affiliated Hospital of Nanchang University, Nanchang, China; Center of Clinical Epidemiology & Biostatistics, Department of Scientific Research, the Second Affiliated Hospital of Zhejiang University College of Medicine, Hangzhou, China.
| | - Chunmao Han
- Department of Burns & Wound Care Center, the Second Affiliated Hospital of Zhejiang University College of Medicine, Hangzhou, China; The Key Laboratory of the Diagnosis and Treatment of Severe Trauma and Burn of Zhejiang Province, Hangzhou, China; Center of Clinical Epidemiology & Biostatistics, Department of Scientific Research, the Second Affiliated Hospital of Zhejiang University College of Medicine, Hangzhou, China.
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Wang Y, Zhu Z, Duan D, Xu W, Chen Z, Shen T, Wang X, Xu Q, Zhang H, Han C. Ultra-restrictive red blood cell transfusion strategies in extensively burned patients. Sci Rep 2024; 14:2848. [PMID: 38310116 PMCID: PMC10838330 DOI: 10.1038/s41598-024-52305-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 01/17/2024] [Indexed: 02/05/2024] Open
Abstract
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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Affiliation(s)
- Yiran Wang
- Department of Burns & Wound Care Center, The Second Affiliated Hospital of Zhejiang University College of Medicine, Hangzhou, 310009, China
- The Key Laboratory of the Diagnosis and Treatment of Severe Trauma and Burn of Zhejiang Province, Hangzhou, China
| | - Zhikang Zhu
- Department of Burns & Wound Care Center, The Second Affiliated Hospital of Zhejiang University College of Medicine, Hangzhou, 310009, China
- The Key Laboratory of the Diagnosis and Treatment of Severe Trauma and Burn of Zhejiang Province, Hangzhou, China
| | - Deqing Duan
- Department of Burns, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Wanting Xu
- Department of Burn Injury, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Zexin Chen
- Center of Clinical Epidemiology & Biostatistics, Department of Scientific Research, The Second Affiliated Hospital of Zhejiang University College of Medicine, Hangzhou, China
| | - Tao Shen
- Department of Burns & Wound Care Center, The Second Affiliated Hospital of Zhejiang University College of Medicine, Hangzhou, 310009, China
| | - Xingang Wang
- Department of Burns & Wound Care Center, The Second Affiliated Hospital of Zhejiang University College of Medicine, Hangzhou, 310009, China.
- The Key Laboratory of the Diagnosis and Treatment of Severe Trauma and Burn of Zhejiang Province, Hangzhou, China.
| | - Qinglian Xu
- Department of Burn Injury, The First Affiliated Hospital of Anhui Medical University, Hefei, China.
| | - Hongyan Zhang
- Department of Burns, The First Affiliated Hospital of Nanchang University, Nanchang, China.
| | - Chunmao Han
- Department of Burns & Wound Care Center, The Second Affiliated Hospital of Zhejiang University College of Medicine, Hangzhou, 310009, China.
- The Key Laboratory of the Diagnosis and Treatment of Severe Trauma and Burn of Zhejiang Province, Hangzhou, China.
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