1
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Long T, Hu X, Liu T, Hu G, Fu J, Fu J. A Nomogram of Predicting Healthcare-Associated Infections in Burned Children. Pediatr Infect Dis J 2024:00006454-990000000-01002. [PMID: 39259855 DOI: 10.1097/inf.0000000000004514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/13/2024]
Abstract
BACKGROUND Healthcare-associated infections (HAIs) are a common clinical concern associated with adverse prognosis and mortality in burned children. This study aimed to construct a predictive nomogram of the risk of HAIs in burned children. METHODS Children admitted to the burn unit of Wuhan Third Hospital between 2020 and 2022 were included. The univariate and multivariate logistic regression analyses were adopted to ascertain predictors of HAIs. A nomogram was developed to predict the HAI risk of each patient, with receiver operating characteristic curves and calibration curves being generated to assess its predictive ability. Furthermore, decision and impact curves were used to assess the clinical utility. RESULTS Of 1122 burned children, 61 (5.5%) patients experienced HAIs. The multivariate analysis indicated that total burn surface area, length of stay, surgery, central venous catheter use and urinary catheter use were the independent risk factors of HAIs. Using these variables, we developed a predictive nomogram of the occurrence of HAIs in burned children, and the internal validation results demonstrated good discrimination and calibration of the nomogram. The area under the curve values of the nomogram was 0.926 (95% CI, 0.896-0.957). The calibration curve showed high consistency between the actual and predicted HAIs. The decision and impact curve indicated that the nomogram was of good clinical utility and more credible net clinical benefits in predicting HAIs. CONCLUSIONS The present study constructed a nomogram for predicting the risk of HAIs in burned children. This nomogram may strengthen the effective screening of patients at high risk of HAIs.
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Affiliation(s)
- Tengfei Long
- From the Department of Infection Prevention and Control
| | - Xuejiao Hu
- AIDS Prevention Institute, Wuhan Center for Disease Control and Prevention, Wuhan, China
| | - Ting Liu
- Department of Pediatrics, Wuhan Third Hospital, Tongren Hospital of Wuhan University, Wuhan, China
| | - Guanfeng Hu
- From the Department of Infection Prevention and Control
| | - Jie Fu
- From the Department of Infection Prevention and Control
| | - Jing Fu
- From the Department of Infection Prevention and Control
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2
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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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3
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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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4
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Impairment of μ-calpain activation by rhTNFR:Fc reduces severe burn-induced membrane disruption in the heart. Cell Death Dis 2022; 8:10. [PMID: 35013173 PMCID: PMC8748603 DOI: 10.1038/s41420-021-00810-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 12/02/2021] [Accepted: 12/16/2021] [Indexed: 11/08/2022]
Abstract
Stress cardiomyopathy is a major clinical complication after severe burn. Multiple upstream initiators have been identified; however, the downstream targets are not fully understood. This study assessed the role of the plasma membrane in this process and its relationship with the protease μ-calpain and tumor necrosis factor-alpha (TNF-α). Here, third-degree burn injury of approximately 40% of the total body surface area was established in rats. Plasma levels of LDH and cTnI and cardiac cell apoptosis increased at 0.5 h post burn, reached a peak at 6 h, and gradually declined at 24 h. This effect correlated well with not only the disruption of cytoskeletal proteins, including dystrophin and ankyrin-B, but also with the activation of μ-calpain, as indicated by the cleaved fragments of α-spectrin and membrane recruitment of the catalytic subunit CAPN1. More importantly, these alterations were diminished by blocking calpain activity with MDL28170. Burn injury markedly increased the cellular uptake of Evans blue, indicating membrane integrity disruption, and this effect was also reversed by MDL28170. Compared with those in the control group, cardiac cells in the burn plasma-treated group were more prone to damage, as indicated by a marked decrease in cell viability and increases in LDH release and apoptosis. Of note, these alterations were mitigated by CAPN1 siRNA. Moreover, after neutralizing TNF-α with rhTNFR:Fc, calpain activity was blocked, and heart function was improved. In conclusion, we identified μ-calpain as a trigger for severe burn-induced membrane disruption in the heart and provided evidence for the application of rhTNFR:Fc to inhibit calpain for cardioprotection.
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5
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Gibson BHY, Wollenman CC, Moore-Lotridge SN, Keller PR, Summitt JB, Revenko AR, Flick MJ, Blackwell TS, Schoenecker JG. Plasmin drives burn-induced systemic inflammatory response syndrome. JCI Insight 2021; 6:154439. [PMID: 34877937 PMCID: PMC8675186 DOI: 10.1172/jci.insight.154439] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 10/27/2021] [Indexed: 12/12/2022] Open
Abstract
Severe injuries, such as burns, provoke a systemic inflammatory response syndrome (SIRS) that imposes pathology on all organs. Simultaneously, severe injury also elicits activation of the fibrinolytic protease plasmin. While the principal adverse outcome of plasmin activation in severe injury is compromised hemostasis, plasmin also possesses proinflammatory properties. We hypothesized that, following a severe injury, early activation of plasmin drives SIRS. Plasmin activation was measured and related to injury severity, SIRS, coagulopathy, and outcomes prospectively in burn patients who are not at risk of hemorrhage. Patients exhibited early, significant activation of plasmin that correlated with burn severity, cytokines, coagulopathy, and death. Burn with a concomitant, remote muscle injury was employed in mice to determine the role of plasmin in the cytokine storm and inflammatory cascades in injured tissue distant from the burn injury. Genetic and pharmacologic inhibition of plasmin reduced the burn-induced cytokine storm and inflammatory signaling in injured tissue. These findings demonstrate (a) that severe injury-induced plasmin activation is a key pathologic component of the SIRS-driven cytokine storm and SIRS-activated inflammatory cascades in tissues distant from the inciting injury and (b) that targeted inhibition of plasmin activation may be effective for limiting both hemorrhage and tissue-damaging inflammation following injury.
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Affiliation(s)
| | - Colby C Wollenman
- School of Medicine.,Department of Orthopaedic Surgery, Vanderbilt University Medical Center
| | - Stephanie N Moore-Lotridge
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center.,Vanderbilt Center for Bone Biology
| | | | - J Blair Summitt
- Department of Plastic Surgery, Vanderbilt University Medical Center; and.,Vanderbilt University Medical Center Burn Center, Vanderbilt University, Nashville, Tennessee, USA
| | - Alexey R Revenko
- IONIS Pharmaceuticals Pulmonary and Oncology Drug Discovery, Carlsbad, California, USA
| | - Matthew J Flick
- Department of Pathology, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, USA.,University of North Carolina Blood Research Center, Chapel Hill, North Carolina, USA
| | - Timothy S Blackwell
- Department of Cancer Biology, Vanderbilt University, Nashville, Tennessee, USA.,Division of Pulmonary and Critical Care
| | - Jonathan G Schoenecker
- Department of Pharmacology.,Department of Orthopaedic Surgery, Vanderbilt University Medical Center.,Vanderbilt Center for Bone Biology.,Department of Pathology, Microbiology, and Immunology; and.,Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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6
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An Epidemiological Study of Burn Cases from a Single Referral Hospital in Indore, Central Part of India and a Proposal for Burn Prevention and Care Program. Indian J Surg 2021. [DOI: 10.1007/s12262-020-02124-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
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7
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Yeong EK, Sheng WH. Does early bloodstream infection pose a significant risk of in-hospital mortality in adults with burns? JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2021; 55:95-101. [PMID: 33563562 DOI: 10.1016/j.jmii.2021.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 01/18/2021] [Accepted: 01/18/2021] [Indexed: 01/25/2023]
Abstract
BACKGROUD/PURPOSE Bloodstream infections (BSI) are common in patients with major burns, but its effect on mortality remains controversial. This study was aimed to investigate if BSI is significant risk factor of mortality? METHODS This is a retrospective chart review study included 266 adult patients admitted to our burn center from 2000 to 2019. Age, sex, inhalation injuries, total burn surface area (TBSA), duration of stay in intensive care unit, BSI and mortality were variables studied. Fisher exact test, Mann-Whitney test and logistic regression was used for statistical analysis. RESULTS There were 234 survivors and 32 non-survivors. Male was predominant. The overall incidence of BSI was 18.8%, and the overall crude mortality was 12%. Burns ≥30% TBSA and BSI were significant risk factors. A predictive function based on30% TBSA and BSI within 14 days after the onset of burns (BSI-14) was derived. The function has a sensitivity of 0.97, specificity of 0.42 and achieved a maximum Youden Index at functional value ≥0.05727. The mortality probability of BSI-14 in burns ≥30% TBSA was 40.8%. CONCLUSIONS BSI and burns ≥30% TBSA were significant risk factors of mortality. Early detection of BSI-14 is critical in burn care as its probability of mortality can be as high as 40% in patients ≥30% TBSA of burns. To reduce the risk of mortality, early in ventilator withdrawal, invasive lines and tubes removal, and early grafting should be emphasized besides infection control and appropriate use of antibiotics.
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Affiliation(s)
- Eng-Kean Yeong
- Surgical Department Plastic Division Burn Centre, National Taiwan University Hospital, Taipei, Taiwan
| | - Wang-Huei Sheng
- Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
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8
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Zhou J, Tan J, Gong Y, Li N, Luo G. Candidemia in major burn patients and its possible risk factors: A 6-year period retrospective study at a burn ICU. Burns 2019; 45:1164-1171. [PMID: 30686692 DOI: 10.1016/j.burns.2019.01.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 12/26/2018] [Accepted: 01/03/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The aims of this study were to evaluate the epidemiological and clinical characteristics of candidemia in a typical burn ICU, and to determine the risk factors associated with candidemia among major burn patients. METHOD This retrospective observational study of candidemia from 2012 to 2017 in a burn ICU was conducted in the Department of Burn, Southwest hospital, Chongqing, China. RESULTS The study included 410 major burn patients (≥40% total body surface area), 39 (9.51%) of which were diagnosed with candidemia. The annual incidences of candidemia varied from 6.06% to 17.54%, and increased gradually in the 6 years. Candida parapsilosis was the dominant pathogen (28.21% strains). The overall resistance rate of Candida spp. to fluconazole was 35.89%. Candidemia cases most frequently occurred in the 2nd (30.77%) and 3rd (23.08%) weeks after burn, and intravascular catheters were the most common sources of bloodstream Candida infections (31.58%). The crude mortality of candidemia was 23.08%, and the mortality attributable to candidemia was 14.99%. Risk factors of candidemia included inhalation injury, renal dysfunction with replacement therapy, severe gastrointestinal complications, T-cell lymphopenia and prior Candida colonization. CONCLUSION Candidemia has a high incidence and mortality in major burn patients. The changes in etiology and drug sensitivity may make new challenges for the management of candidemia in burn ICUs.
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Affiliation(s)
- Junyi Zhou
- State Key Laboratory of Trauma, Burn and Combined Injury, Institute of Burn Research, Southwest Hospital, the Third Military Medical University, Chongqing 400038, China
| | - Jianglin Tan
- State Key Laboratory of Trauma, Burn and Combined Injury, Institute of Burn Research, Southwest Hospital, the Third Military Medical University, Chongqing 400038, China
| | - Yali Gong
- State Key Laboratory of Trauma, Burn and Combined Injury, Institute of Burn Research, Southwest Hospital, the Third Military Medical University, Chongqing 400038, China
| | - Ning Li
- State Key Laboratory of Trauma, Burn and Combined Injury, Institute of Burn Research, Southwest Hospital, the Third Military Medical University, Chongqing 400038, China
| | - Gaoxing Luo
- State Key Laboratory of Trauma, Burn and Combined Injury, Institute of Burn Research, Southwest Hospital, the Third Military Medical University, Chongqing 400038, China.
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9
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Cheung M, Cobb AN, Kuo PC. Predicting burn patient mortality with electronic medical records. Surgery 2018; 164:839-847. [PMID: 30174140 DOI: 10.1016/j.surg.2018.07.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 07/10/2018] [Accepted: 07/16/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND Although there exists robust literature on mortality-associated factors in burn patients, it is not known how electronic medical records affect outcomes. Using burn injury as a surgical care model of information and communication, we hypothesized that functionality and interoperability of the electronic medical record could serve as determinants of outcome. METHODS We used the state inpatient databases for New York, Washington, California, and Florida for the years 2009 and 2010 for all states, with the additional years of 2012 and 2013 for New York (n = 6,002), and the respective data from the American Hospital Association Information Technology survey. Using International Classification of Diseases, Ninth Revision, codes, we included burn patients and characterized total body surface area burned. We summed the binary answers to questions 1 and 2 and question 3 from the American Hospital Association Information Technology survey to make continuous functionality and interoperability scores. Mortality was predicted using extreme gradient boosting in Python. RESULTS In each state in which our models had an accuracy and area under the curve of more than 0.90, electronic medical record functionality but not interoperability was a significant predictor in New York, California, and Florida. Important predictors in each state were, age, duration of stay, total body surface area burned/severity, and total charges. Electronic medical record functionality was more important than all comorbidities except for coagulopathies and electrolyte disorders. Higher functionality scores were associated with mortality (P < .01). CONCLUSION Our data support our hypothesis that electronic medical records may be associated with mortality in burn patients; however, electronic medical records are not having the intended impact on outcomes, and further research needs to elucidate exactly how electronic medical records are being used in clinical settings.
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Affiliation(s)
- Matthew Cheung
- Department of Surgery, Loyola University Medical Center, Maywood, IL.
| | - Adrienne N Cobb
- Department of Surgery, Loyola University Medical Center, Maywood, IL; One:MAP Division of Clinical Informatics and Analytics, Department of Surgery, Loyola University Chicago, IL
| | - Paul C Kuo
- Department of Surgery, University of South Florida, Tampa, FL
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10
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Feng JY, Chien JY, Kao KC, Tsai CL, Hung FM, Lin FM, Hu HC, Huang KL, Yu CJ, Yang KY. Predictors of Early Onset Multiple Organ Dysfunction in Major Burn Patients with Ventilator Support: Experience from A Mass Casualty Explosion. Sci Rep 2018; 8:10939. [PMID: 30026512 PMCID: PMC6053465 DOI: 10.1038/s41598-018-29158-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 05/04/2018] [Indexed: 11/09/2022] Open
Abstract
Organ dysfunction is common in patients with major burns and associated with poor outcomes. The risk factors for early onset multiple organ dysfunction syndrome (MODS) in major burn patients with invasive ventilator support has rarely been evaluated before. In this study, major burn patients with invasive ventilator support from 499 victims suffered in a mass casualty color dust explosion were retrospectively enrolled. The development of early MODS that occurred within 5 days after burn injury was determined and the risk factors associated with early MODS were analyzed. A total of 88 patients from five medical centers were included. Their mean total body surface area (TBSA) was 60.9 ± 15.8%, and 45 (51.1%) patients had early MODS. Hematologic failure was the most common organ failure (68.6%), followed by respiratory failure (48.9%). Independent clinical factors associated with early MODS included TBSA ≥55% (OR: 3.83; 95% CI: 1.29-11.37) and serum albumin level <2.1 g/dL upon admission (OR: 3.43; 95% CI: 1.01-11.57). Patients with early MODS had prolonged ventilator dependence and longer ICU admission than those without early MODS. Our results showed that early MODS in major burn patients with invasive ventilator support is very common and can be predicted early on admission.
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Affiliation(s)
- Jia-Yih Feng
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Jung-Yien Chien
- Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Kuo-Chin Kao
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Department of Respiratory Therapy, Chang Gung University, Taoyuan, Taiwan
| | - Cheng-Liang Tsai
- Division of Pulmonary and Critical Care, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Fang Ming Hung
- Department of Surgical Intensive Care Unit, Far Eastern Memorial Hospital, New Taipei, Taiwan
| | - Fan-Min Lin
- Division of Pulmonary Medicine, Department of Internal Medicine, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan
| | - Han-Chung Hu
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Department of Respiratory Therapy, Chang Gung University, Taoyuan, Taiwan
| | - Kun-Lun Huang
- Graduate Institute of Aerospace and Undersea Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Chong-Jen Yu
- Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Kuang-Yao Yang
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan. .,Institute of Emergency and Critical Care Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
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11
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Tao L, Zhou J, Gong Y, Liu W, Long T, Huang X, Luo G, Peng Y, Wu J. Risk factors for central line-associated bloodstream infection in patients with major burns and the efficacy of the topical application of mupirocin at the central venous catheter exit site. Burns 2015; 41:1831-1838. [DOI: 10.1016/j.burns.2015.08.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Revised: 07/26/2015] [Accepted: 08/08/2015] [Indexed: 10/23/2022]
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12
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Dong ZW, Chen J, Ruan YC, Zhou T, Chen Y, Chen Y, Tsang LL, Chan HC, Peng YZ. CFTR-regulated MAPK/NF-κB signaling in pulmonary inflammation in thermal inhalation injury. Sci Rep 2015; 5:15946. [PMID: 26515683 PMCID: PMC4626762 DOI: 10.1038/srep15946] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 09/30/2015] [Indexed: 12/17/2022] Open
Abstract
The mechanism underlying pulmonary inflammation in thermal inhalation injury remains elusive. Cystic fibrosis, also hallmarked with pulmonary inflammation, is caused by mutations in CFTR, the expression of which is temperature-sensitive. We investigated whether CFTR is involved in heat-induced pulmonary inflammation. We applied heat-treatment in 16HBE14o- cells with CFTR knockdown or overexpression and heat-inhalation in rats in vivo. Heat-treatment caused significant reduction in CFTR and, reciprocally, increase in COX-2 at early stages both in vitro and in vivo. Activation of ERK/JNK, NF-κB and COX-2/PGE2 were detected in heat-treated cells, which were mimicked by knockdown, and reversed by overexpression of CFTR or VX-809, a reported CFTR mutation corrector. JNK/ERK inhibition reversed heat-/CFTR-knockdown-induced NF-κB activation, whereas NF-κB inhibitor showed no effect on JNK/ERK. IL-8 was augmented by heat-treatment or CFTR-knockdown, which was abolished by inhibition of NF-κB, JNK/ERK or COX-2. Moreover, in vitro or in vivo treatment with curcumin, a natural phenolic compound, significantly enhanced CFTR expression and reversed the heat-induced increases in COX-2/PGE2/IL-8, neutrophil infiltration and tissue damage in the airway. These results have revealed a CFTR-regulated MAPK/NF-κB pathway leading to COX-2/PGE2/IL-8 activation in thermal inhalation injury, and demonstrated therapeutic potential of curcumin for alleviating heat-induced pulmonary inflammation.
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Affiliation(s)
- Zhi Wei Dong
- State Key Laboratory of Trauma, Burns and Combined Injury, Chongqing Key Laboratory for Proteomics Disease, Institute of Burn Research, Southwest Hospital, the Third Military Medical University, Chongqing, China
| | - Jing Chen
- State Key Laboratory of Trauma, Burns and Combined Injury, Chongqing Key Laboratory for Proteomics Disease, Institute of Burn Research, Southwest Hospital, the Third Military Medical University, Chongqing, China
| | - Ye Chun Ruan
- Epithelial Cell Biology Research Center, School of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, People's Republic of China
| | - Tao Zhou
- State Key Laboratory of Trauma, Burns and Combined Injury, Chongqing Key Laboratory for Proteomics Disease, Institute of Burn Research, Southwest Hospital, the Third Military Medical University, Chongqing, China
| | - Yu Chen
- State Key Laboratory of Trauma, Burns and Combined Injury, Chongqing Key Laboratory for Proteomics Disease, Institute of Burn Research, Southwest Hospital, the Third Military Medical University, Chongqing, China
| | - YaJie Chen
- State Key Laboratory of Trauma, Burns and Combined Injury, Chongqing Key Laboratory for Proteomics Disease, Institute of Burn Research, Southwest Hospital, the Third Military Medical University, Chongqing, China
| | - Lai Ling Tsang
- Epithelial Cell Biology Research Center, School of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, People's Republic of China
| | - Hsiao Chang Chan
- Epithelial Cell Biology Research Center, School of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, People's Republic of China
| | - Yi Zhi Peng
- State Key Laboratory of Trauma, Burns and Combined Injury, Chongqing Key Laboratory for Proteomics Disease, Institute of Burn Research, Southwest Hospital, the Third Military Medical University, Chongqing, China
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Modeling Fluid Resuscitation by Formulating Infusion Rate and Urine Output in Severe Thermal Burn Adult Patients: A Retrospective Cohort Study. BIOMED RESEARCH INTERNATIONAL 2015; 2015:508043. [PMID: 26090415 PMCID: PMC4442020 DOI: 10.1155/2015/508043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 04/24/2015] [Indexed: 11/17/2022]
Abstract
Acute burn injuries are among the most devastating forms of trauma and lead to significant morbidity and mortality. Appropriate fluid resuscitation after severe burn, specifically during the first 48 hours following injury, is considered as the single most important therapeutic intervention in burn treatment. Although many formulas have been developed to estimate the required fluid amount in severe burn patients, many lines of evidence showed that patients still receive far more fluid than formulas recommend. Overresuscitation, which is known as “fluid creep,” has emerged as one of the most important problems during the initial period of burn care. If fluid titration can be personalized and automated during the resuscitation phase, more efficient burn care and outcome will be anticipated. In the present study, a dynamic urine output based infusion rate prediction model was developed and validated during the initial 48 hours in severe thermal burn adult patients. The experimental results demonstrated that the developed dynamic fluid resuscitation model might significantly reduce the total fluid volume by accurately predicting hourly urine output and has the potential to aid fluid administration in severe burn patients.
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