Early Low Level of Procalcitonin Is Associated with a Favorable Outcome in a Case of a Surviving Patient with 80% Body Surface Area Thermal Burn.

BACKGROUND Burns covering a large skin surface area represent a life-threatening condition due to the release of cytokines and the activation of a systemic inflammatory response, as well as the potential for septic complications. Outcome for these patients is related to the burn surface, age, and coexisting diseases. Although some severity scores are available, such as the Abbreviated Burn Severity Index (ABSI), Baux score, R-Baux score, Boston score, and Belgian Outcome Burn Injury (BOBI) score, none can provide a solid picture of the final outcome. Recent studies claim that procalcitonin, a known sepsis marker, can assist in estimating a burn patient's chance of survival from the time of admission, and can also assist in estimating the chance of sepsis occurrence during hospitalization. CASE REPORT In this manuscript we report the case of a 28-year-old man who suffered burn injuries on approximately 80% of his body surface due to poor handling of a gasoline can in August 2018. Despite high severity index scores and early high values of C-reactive protein, we noticed a low level of early procalcitonin. In this case, as well in our previous experience, early low procalcitonin was associated with a favorable outcome. CONCLUSIONS Early procalcitonin values might prove to be a promising prognosis marker in some cases of extensive burns.

Surgical treatment for severe liver injuries: a single-center experience.

BACKGROUND: The liver is one of the most frequently injured organs in abdominal trauma. The advancements in diagnosis and interventional therapy shifted the management of liver trauma towards a non-operative management (NOM). Nevertheless, in severe liver injuries (LI), surgical treatment often involving liver resection (LR) and rarely liver transplantation (LT) remains the main option. The present paper analyses a single center experience in a referral HPB center on a series of patients with high-grade liver trauma. METHODS: Forty-five patients with severe LI, that benefitted from NOM (6 pts), LRs (38 pts), and LT (1 pt) performed in our center between June 2000 and June 2019, were included in a combined prospective and retrospective study. The median age of the patients was 29 years (median 33, range 10-76), and the male/female ratio of 33/12. Almost all cases had blunt trauma, except 2 with stab wound (4.4%). RESULTS: LIs classified according to the American Association for the Surgery of Trauma (AAST) system were 13.3% (grade III), 44.2% (grade IV), and 42.2% (grade V); none were grade I, II or VI. The rate of major LR was 56.4% (22 LRs). The median operative time was 200 minutes (mean 236; range 150-420). The median blood loss was 750 ml (mean 940; range 500-6500). Overall and major complication rates were 100% (45 pts) and 33.3% (15 pts), respectively. Overall mortality rate was 15.6% (7 pts). CONCLUSIONS: Severe liver trauma, often involving complex liver resections, should be managed in a referral HPB center, thus obtaining the best results in terms of morbidity and mortality.