Aspartate transaminase/alanine transaminase (De Ritis ratio) predicts survival in major burn patients.

BACKGROUND: Although treatment of burn patients has significantly improved in recent decades, major burns remain fatal. Therefore, the evaluation of the death risk of the patients with extensive burns is very important. The ratio between the serum levels of aspartate transaminase and alanine transaminase (De Ritis ratio) was an independent predictor of poor outcomes in patients with acute ischemic stroke, cardiac surgery, non-metastatic renal cell carcinoma, and upper urinary tract urothelial carcinoma. Our aim was to determine whether the ratio between the serum levels of AST and ALT (De Ritis ratio) was useful to assess prognosis in extensively burned patients. METHODS: We conducted a single-center cohort study at the Burns Department of Changhai Hospital. This retrospective observational analysis was performed based on the clinical data of major burn patients admitted between May 1, 2005 and April 30, 2018. Univariate and multivariate logistic regression analyses were performed on variables such as age, sex, total body surface area (TBSA), De Ritis ratio, and serum albumin level, which may affect mortality in major burn patients. We assessed their diagnostic value and found the cut-off value by receiver operative characteristic (ROC) curve analysis. We used the Kaplan-Meier curve to display the impact of the De Ritis ratio and serum albumin level on survival in burn patients. RESULTS: A total of 351 patients with extensive burns were included in the study. The cohort predominantly consisted of males (74.64%), and most of the patients (78.35%) had been burned by a flame. Age, TBSA, inhalation, and the De Ritis ratio were found to be independent risk factors for the 30-days mortality of major burn patients, while age, TBSA, inhalation, and the De Ritis ratio were independent risk factors for 90-day mortality. Further, the De Ritis ratio was a better mortality predictor than serum albumin in severely burned patients, whose area under ROC for 30-day and 90-day mortality was 0.771 (95% confidence intervals [CI], 0.708-0.835) and 0.750 (95% CI, 0.683, 0.818). CONCLUSIONS: The De Ritis ratio was useful as a prognostic indicator for major burn patients, which can be conveniently obtained through blood examination. Regardless of whether the prediction was for 30-day or 90-day mortality, the accuracy remained high. Moreover, compared to serum albumin level, the De Ritis ratio was superior in assessing the prognosis of extensively burned patients.

Incidence and Mortality of Acute Respiratory Distress Syndrome in Patients With Burns: A Systematic Review and Meta-Analysis.

Objective: We conducted a systematic review and meta-analysis to comprehensively estimate the incidence and mortality of acute respiratory distress syndrome (ARDS) in overall and subgroups of patients with burns. Data sources: Pubmed, Embase, the Cochrane Library, CINAHL databases, and China National Knowledge Infrastructure database were searched until September 1, 2021. Study selection: Articles that report study data on incidence or mortality of ARDS in patients with burns were selected. Data extraction: Two researchers independently screened the literature, extracted data, and assessed the quality. We performed a meta-analysis of the incidence and mortality of ARDS in patients with burns using a random effects model, which made subgroup analysis according to the study type, inclusion (mechanical ventilation, minimal burn surface), definitions of ARDS, geographic location, mean age, burn severity, and inhalation injury. Primary outcomes were the incidence and mortality of burns patients with ARDS, and secondary outcomes were incidence for different subgroups. Data synthesis: Pooled weighted estimate of the incidence and mortality of ARDS in patients with burns was 0.24 [95% confidence interval (CI)0.2-0.28] and 0.31 [95% CI 0.18-0.44]. Incidences of ARDS were obviously higher in patients on mechanical ventilation (incidence = 0.37), diagnosed by Berlin definition (incidence = 0.35), and with over 50% inhalation injury proportion (incidence = 0.41) than in overall patients with burns. Patients with burns who came from western countries and with inhalation injury have a significantly higher incidence of ARDS compared with those who came from Asian/African countries (0.28 vs. 0.25) and without inhalation injury (0.41 vs. 0.24). Conclusion: This systematic review and meta-analysis revealed that the incidence of ARDS in patients with burns is 24% and that mortality is as high as 31%. The incidence rates are related to mechanical ventilation, location, and inhalation injury. The patients with burns from western countries and with inhalation injury have a significantly higher incidence than patients from Asian/African countries and without inhalation injury. Systematic Review Registration: identifier: CRD42021144888.

Comorbidities of scars in China: a national study based on hospitalized cases.

BACKGROUND: Scar comorbidities seriously affect the physical and mental health of patients, but few studies have reported the exact epidemiological characteristics of scar comorbidities in China. This study aimed to investigate the prevalence of scar comorbidities in China. METHODS: The data of 177,586 scar cases between 2013 and 2018 were obtained from the Hospital Quality Monitoring System based on the 10th edition of the International Classification of Diseases coding system. The total distribution of scar comorbidities and their relationship with age, aetiology and body regions were analysed. RESULTS: Six comorbidities (contracture, malformation, ocular complications, adhesion, infection and others) were the main focus. In general, male patients outnumbered females and urban areas outnumbered rural areas. The proportion of contractures was the highest at 59,028 (33.24%). Students, workers and farmers made up the majority of the occupation. Han Chinese accounted for the majority of the ethnic. The highest proportion of scar contracture occurred at 1-1.9 years of age (58.97%), after which a significant downward trend was observed. However, starting from 50 years of age, ocular complications increased gradually and significantly, eventually reaching a peak of 34.49% in those aged >80 years. Scar contracture was the most common comorbidity according to aetiology, and the highest proportion was observed in patients who were scalded (29.33%). Contractures were also the most frequent comorbidity in hands (10.30%), lower limbs (6.97%), feet (6.80%) and upper limbs (6.02%). The mean and median hospitalization durations were 12.85 and 8 days, respectively. CONCLUSIONS: Contractures were the most common comorbidities, and different comorbidities tended to occur at different ages and with different causative factors.

Association of Preadmission Statin Use and Mortality in Critically Ill Patients: A Meta-Analysis of Cohort Studies.

Background: A large number of studies have been conducted to determine whether there is an association between preadmission statin use and improvement in outcomes following critical illness, but the conclusions are quite inconsistent. Therefore, this meta-analysis aims to include the present relevant PSM researches to examine the association of preadmission use of statins with the mortality of critically ill patients. Methods: The PubMed, Web of Science, Embase electronic databases, and printed resources were searched for English articles published before March 6, 2020 on the association between preadmission statin use and mortality in critically ill patients. The included articles were analyzed in RevMan 5.3. The Newcastle-Ottawa Scale (NOS) was used to conduct quality evaluation, and random/fixed effects modeling was used to calculate the pooled ORs and 95% CIs. We also conducted subgroup analysis by outcome indicators (30-, 90-day, hospital mortality). Results: All six PSM observational studies were assessed as having a low risk of bias according to the NOS. For primary outcome-overall mortality, the pooled OR (preadmission statins use vs. no use) across the six included studies was 0.86 (95% CI, 0.76-0.97; P = 0.02). For secondary outcome-use of mechanical ventilation, the pooled OR was 0.94 (95% CI, 0.91-0.97; P = 0.0005). The corresponding pooled ORs were 0.67 (95% CI, 0.43-1.05; P = 0.08), 0.91 (95% CI, 0.83-1.01; P = 0.07), and 0.86 (95% CI, 0.83-0.89; P < 0.00001) for 30-, 90-day, and hospital mortality, respectively. Conclusions: Preadmission statin use is associated with beneficial outcomes in critical ill patients, indicating a lower short-term mortality, less use of mechanical ventilation, and an improvement in hospital survival. Further high-quality original studies or more scientific methods are needed to draw a definitive conclusion.

[Epidemiological characteristics and outcome analysis of inhalation injury patients combined with burn area less than 30% total body surface area in a single center from 2008 to 2016].

Objective: To explore the epidemiological characteristics and treatment outcomes of inhalation injury patients combined with burn area less than 30% total body surface area (TBSA) admitted to the First Affiliated Hospital of Naval Medical University. Methods: Retrospective observational study with performed on medical records of 266 inhalation injury patients combined with burn area less than 30% TBSA who were admitted to the First Affiliated Hospital of Naval Medical University from January 2008 to September 2016 and met the inclusion criteria. The gender, age, injured site, injurious factors of inhalation injury, degree of inhalation injury, combined total burn area, way of tracheotomy, time of tracheotomy, whether conducted mechanical ventilation or not, whether in intensive care unit (ICU) or not, microbial culture results of bronchoalveolar lavage, total hospitalization days, ICU days, mechanical ventilation days, and whether respiratory infections occurred or not. Single factor and multivariate linear regression analysis was used to screen out the risk factors impacting the total hospitalization days, ICU days, and mechanical ventilation days of patients. Single factor and multivariate logistic regression analysis was used to screen out the risk factors impacting respiratory infections of patients. Results: The 266 patients included 190 males and 76 females, with the majority age of above and equal to 21 and below 65 years (217 patients). Confined space was the major injured site. Hot air was the major factor of inhalation injury. Mild and moderate inhalation injuries were commonly seen in patients. The combined total burn area was 9.00 (3.25, 18.00) %TBSA. In 111 patients who were conducted with tracheotomy, the most were conducted before admitted to the First Affiliated Hospital of Naval Medical University. The total hospitalization days of patients were 27 (10, 55) days. The ICU days of 160 patients were 15.5 (6.0, 40.0) days. The mechanical ventilation days of 109 patients were 6.0 (1.3, 11.5) days. A total of 119 patients were diagnosed with respiratory infections, with 548 strains including 35 types of pathogens were isolated, mainly of Gram-negative bacteria. Single factor linear regression analysis showed age, injurious factors of inhalation injury, combined total burn area, degree of inhalation injury, way of tracheotomy, whether conducted mechanical ventilation or not, and whether respiratory infections occurred or not were the risk factors impacting the total hospitalization days of patients (95% confidence interval (CI)=-0.397－0.001, -0.395－-0.053, 0.015－0.028, 0.009－0.263, 0.008－0.319, -0.419－-0.176, 0.242－0.471, 0.340－0.555, P<0.1). Multivariate linear regression analysis showed smoke inhalation, mechanical ventilation, and respiratory infections were the independent risk factors impacting the total hospitalization days of patients (95% CI=-0.384－0.082, 0.022－0.271, 0.261－0.506, P<0.05 or P<0.01). Single factor linear regression analysis showed injurious factors of inhalation injury, combined total burn area, degree of inhalation injury, way of tracheotomy, whether conducted mechanical ventilation or not, and whether respiratory infections occurred or not were the risk factors impacting the ICU days of patients (95% CI=0.053－0.502, 0.006－0.010, -0.018－0.457, -0.022－0.428, -0.575－-0.241, -0.687－-0.018, 0.132－0.486, 0.369－0.678, P<0.1). Multivariate linear regression analysis showed that no tracheotomy and respiratory infections were the independent risk factors impacting the ICU days of patients (95% CI=-0.414－-0.084, 0.278－0.601, P<0.01). Single factor linear regression analysis showed injured site, injurious factors of inhalation injury, combined total burn area, degree of inhalation injury, way of tracheotomy, and whether respiratory infections occurred or not were the risk factors impacting mechanical ventilation days of patients (95% CI=-0.565－-0.034, 0.145－0.946, 0.051－1.188, 0.001－0.009, 0.127－0.847, 0.436－1.162, -1.243－-0.229, 0.005－0.605, P<0.1). Multivariate linear regression analysis showed open space inhalation, smoke inhalation, severe inhalation injury, no tracheotomy, prophylactic tracheotomy, and respiratory infections were the independent risk factors impacting mechanical ventilation days of patients (95% CI=-0.588－-0.127, 0.138－0.560, 0.143－0.848, -0.909－-0.330, -1.008－-0.015, 0.007－0.519, P<0.05 or P<0.01). Single factor logistic regression analysis showed age, injured site, degree of inhalation injury, combined total burn area, way of tracheotomy, and whether conducted mechanical ventilation or not were the risk factors impacting respiratory infections of patients (95% CI=0.840－1.362, 0.641－1.044, 1.122－1.526, 1.028－1.661, 1.344－2.405, 1.460－2.612, 0.744－1.320, 0.241－0.424, 2.331－4.090, P<0.1). Multivariate logistic regression analysis showed prophylactic tracheotomy, no tracheotomy, and mechanical ventilation were the independent risk factors impacting respiratory infections of patient (95% CI=0.430－0.641, 0.290－0.511, 2.152－8.624, P<0.05 or P<0.01). Conclusions: The inhalation injury patients combined with burn area less than 30% TBSA are mainly young and middle-aged males. Confined space, smoke inhalation, mechanical ventilation, respiratory infection, and way of tracheotomy are influencing factors of the outcomes in hospital of inhalation injury patients combined with burn area less than 30% TBSA. Additionally, prophylactic tracheotomy shows its potential role in avoiding respiratory infection for patients with moderate or severe degree of inhalation injury.

Risk Factors for Transfusion-Related Acute Lung Injury.

BACKGROUND: Until now, transfusion-related acute lung injury (TRALI) has been considered the leading cause of blood transfusion-related diseases and death. In addition, there is no clinically effective treatment plan for TRALI. The aim of this study was to systematically summarize the literature on risk factors for TRALI in critical patients. METHODS: Electronic searches (up to March 2020) were performed in the Cochrane Library, Web of Knowledge, Embase, and PubMed databases. We included studies reporting on the risk factors of TRALI for critical patients and extracted risk factors. A total of 13 studies met the inclusion criteria. RESULTS: We summarized and analyzed the potential risk factors of TRALI for critical patients in 13 existing studies. Host-related factors were age (odds ratio [OR] 1.16 [95% CI 1.08-1.24]), female sex (OR 1.26 [95% CI 1.16-1.38]), tobacco use status (OR 3.82 [95% CI 1.91-7.65]), chronic alcohol abuse (OR 3.82 [95% CI 2.97-26.83]), positive fluid balance (OR 1.24 [95% CI 1.08-1.42]), shock before transfusion (OR 4.41 [95% CI 2.38-8.20]), and American Society of Anesthesiologists (ASA) score of the recipients (OR 2.72 [95% CI 1.43-5.16]). The transfusion-related factors were the number of transfusions (OR 1.40 [95% CI 1.14-1.72]) and units of fresh frozen plasma (OR 1.21 [95% CI 1.01-1.46]). The device-related factor was mechanical ventilation (OR 4.13 [95% CI 2.20-7.76]). CONCLUSIONS: The risk factors that were positively correlated with TRALI in this study included number of transfusions and units of fresh frozen plasma. Age, female sex, tobacco use, chronic alcohol abuse, positive fluid balance, shock before transfusion, ASA score, and mechanical ventilation may be potential risk factors for TRALI. Our results suggest that host-related risk factors may play a more important role in the occurrence and development of TRALI than risk factors related to blood transfusions.

Admission Neutrophil-Lymphocyte Ratio (NLR) Predicts Survival in Patients with Extensive Burns.

BACKGROUND: Extensive burns is one of the most common severe injuries, with a high annual death rate. Previous studies showed that the neutrophil to lymphocyte ratio (NLR) is a prognostic factor for some inflammatory diseases. However, until now, no study has evaluated the clinical prognostic value of NLR in extensively burned patients. The aim of this study was to investigate the prognostic value of NLR in this medical condition to provide clinical guidance. METHODS: 271 patients diagnosed with extensive burns were analysed retrospectively between 2005 and 2018 in the Department of Burn Surgery of Changhai Hospital. NLR cut-off values at the first 3 days of hospitalization were calculated by the ROC analysis. RESULTS: Of the 271 patients in this study, the majority (82.3%) were injured by flame. The median total body surface area (TBSA) was 55% (IQR, 40% to 85%) and the median full thickness burn (FTB) was 20% (IQR, 3%-44%). The patients' NLR declined within the first 3 days after admission, and we found that NLR was negatively correlated with the ventilator-free days at day 28 (r = -0.127, P = 0.048). In a multivariate logistic regression analysis, higher admission NLR was independently predictive of higher mortality. According to the ROC curve, the best cut-off values for day 1 (or admission day), day 2 and day 3 NLR were 14, 13 and 7.5, respectively. We then performed a survival analysis, finding that those NLR above the cut-off point had decreased overall survival compared to those with NLR below the cut-off point (p = 0.023, 0.045 and 0.019 for day 1, 2, and 3, respectively). CONCLUSIONS: NLR continuously decreased in the first 3 days of hospitalization. Admission NLR above 14 is associated with a decreased survival in patients with extensive burns. These findings demonstrate that NLR has prognostic value in these patients.

Liver Resection for Hepatocellular Carcinoma in Non-alcoholic Fatty Liver Disease: a Multicenter Propensity Matching Analysis with HBV-HCC.

BACKGROUND: The incidence of hepatocellular carcinoma (HCC) in non-alcoholic fatty liver disease (NAFLD) is increasing worldwide. Higher perioperative risks may be anticipated due to underlying steatohepatitis, while long-term outcomes after liver resection are unknown. We sought to investigate outcomes after liver resection for NAFLD-HCC versus hepatitis B virus (HBV)-HCC using propensity score matching (PSM). METHODS: Consecutive patients who underwent liver resection for HCC between 2003 and 2014 were identified from a multicenter database. Patients with NAFLD-HCC were matched one-to-one to patients with HBV-HCC. RESULTS: Among 1483 patients identified, 96 (6.5%) had NAFLD-HCC and 1387 (93.5%) had HBV-HCC. Patients with NAFLD-HCC were older (median age 57 vs. 50 years), more often overweight (50.0% vs. 37.5%), less often to have cirrhosis (30.2% vs. 72.5%) and liver dysfunction (Child-Pugh B: 4.2% vs. 10.7%), had larger tumor size (median 7.2 vs. 6.2 cm) yet had better tumor differentiation (27.1% vs. 17.6%) compared with patients with HBV-HCC (all P < 0.05). Perioperative mortality and morbidity were comparable between the two groups (1.0% vs. 1.4% and 20.8% vs. 23.2%, both P > 0.05). No differences were noted in median OS and RFS among patient with NAFLD-HCC versus HBV-HCC before or after PSM. CONCLUSION: While patients with NAFLD-HCC had different clinical characteristics than patients with HBV-HCC, liver resection resulted in similar perioperative outcomes and comparable OS and RFS among patients with NAFLD-HCC and HBV-HCC.