Risk factors for adverse outcome in patients with burn shock
ORIGINAL PAPERS
Abstract
Introduction.Well-recognized risk factors associated with adverse outcomes in intensive care for burn shock include burn area, patient age, time to delay in therapy, and the presence of comorbidities.The aim of the studyis the identification risk factors for mortality in patients with severe burn shock in the early stages of intensive care.Materials and methods.A retrospective cohort study was conducted at the Novosibirsk Regional Clinical Hospital, Intensive Care Unit, Burn Center. The study included 27 patients aged 18 to 65 years with thermal injury (flame burn) with the development of burn shock. All patients were admitted to the intensive care unit within the first 2 hours after exposure to the etiologic factor. Two groups were formed according to the outcome criterion (1 group — survivors, n=16; 2 group — dead, n=11).Results.The time of admission to the intensive care unit from the moment of injury, the age of the patients, and the area of the burn surface did not have a prognostic value regarding the lethal outcome. In 2 group, significant differences in renal damage indicators (urea, blood creatinine) and hypoalbuminemia were revealed from the first day, which persisted at all stages. In the first two days, the infusion volume was significantly higher in 2 group (p=0,026, p=0,023), from the 3dday there was no difference. A significant difference in urine volume for the 1stday (p=0,000) determined the growth of the cumulative fluid balance in 2 group during the three days (p=0,008).Conclusions.A decrease in the diuresis rate in the 1stday (less than 56 ml/hour or 0,8 ml/kg/hour (Se 82%; Sp 94%) for a standard weight of 70 kg) affects the cumulative fluid balance during the first three days of intensive care for burn shock. An increase in the cumulative balance on the 2ndday is a prognostically unfavorable indicator of a fatal outcome.
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