Using mSIS, DNI, CRP, LDH and Albumin Levels for Predicting Burn-related Mortality

Abstract

Objective:After major burn injury, patients suffer from massive systemic inflammatory response. Approximately 54% of burn-related deaths in modern burn units occur due to septic shock and multiple organ dysfunction syndrome instead of osmotic shock and hypovolemia, in 72 hours after admission. Early diagnosis and effective treatment of the sepsis would be a benefit for burn patients, especially those with severe burns. In this study, we aimed to use modified systemic inflammatory score (mSIS), C-reactive protein (CRP), delta neutrophil index (DNI), lactate dehydrogenase (LDH) and albumin (ALB) together to predict mortality of patients suffering from more than 30% of total body surface area (TBSA) burns.Method:Between January 2020 and December 2020, the records of patients admitted to our center were analyzed retrospectively. Demographic and burn-related characteristics of patients and mortality were tabulated. DNI, CRP, serum ALB and LDH levels at the time of admission and discharge were also recorded. mSIS was calculated for all patients based on serum ALB levels and lymphocyte-to-monocyte ratio. The DNI, CRP, LDH and ALB levels both during admission and discharge were analyzed with ROC analysis.Results:Totally 55 severe burn patients were admitted to burn intensive care unit in one year period. The mean age of the patients was 40.8 (18- 89) years and the mean burned TBSA was 40.73%. There were 13 deaths with 23.6% mortality rate. The average length of stay for all patients was 35.3 days where all mortalities occurred after 72 hours of admission. Both admission and discharge CRP levels were significantly high for non-survivals (p=0.001 and p=0.000, respectively). When LDH, ALB and DNI values were compered between the groups, while LDH and DNI discharge levels were significantly high and ALB levels were significantly low for non-survivals, there were no difference at the admission levels. The ROC curve analysis was performed for the eligibility of the inflammatory biomarkers to predict the mortality. Continued high levels of LDH, CRP, and DNI and decreasing ALB levels predicts mortality better than abbreviated burn severity index and rBAUX according to the value of area under ROC curve (0.86, 0.92, 0.84, respectively).Conclusion:Predicting the life expectancy of patient at the time of admission to the burn intensive care unit is the greatest help in deciding the treatment scheme. Burn severity scores are mostly used for mortality prediction, and widely used ones are based on TBSA and age. Sometimes, calculating the TBSA could be difficult especially for the patients referred from primary care. In regard to our study, accurate mortality prediction can be made with CBC, serum ALB and CRP levels and without TBSA. Moreover, during the intensive care unit stay, increasing levels of DNI, LDH and CRP levels and decreasing ALB levels should be alerting for mortality.

Keywords

• albumin
• burn
• crp
• dni
• ldh
• mortality
• msis