A descriptive analysis of a French cohort of burn patients: impact of age and comorbidities on prognosis

Position du problème et objectif(s) de l’étude

Severe burns are a life-threatening emergency. They are associated with a high morbidity and mortality rate and require complex and specialized medical care. Several prognostic scores have been developed to assess burn severity and mortality risk, including patient’s age, which is recognized as a key determinant of prognosis. However, most of these scores do not take into account pre-existing comorbidities, despite evidence in the literature that they have a major impact on the patient prognosis.The aim of this study is to evaluate the impact of age and comorbidities on patient outcomes and to establish a new prognostic score based on the collected data that incorporates comorbidities.

Matériel et méthodes

This study is a retrospective descriptive analysis of data collected from patients admitted in a French burn treatment center between 2012 and 2023. The present study has been approved by the local Ethics Committee (Institutional review board 00003835, protocol 2013/17NICB, PRONOBURN). Descriptive statistics and logistic regression analysis were used to determine the impact of age and comorbidities on burn-related mortality.

Résultats & Discussion

A total of 1,764 patients, 938 (53.2%) were aged 18-50 years, 625 (35.4%) were aged 51–75 years, and 201 (11.4%) were aged ≥76 years. The all-cause mortality rate for the cohort was 9.2% (163 patients). The age group ≥76-year had the highest mortality rate and experienced earlier deaths. An exponential relationship between increasing age and mortality was observed, with 70 years possibly identified as the critical threshold for a notable increase in mortality (Figure 1). Several comorbidities were independently associated with mortality, including cancer (OR= 2,40; CI95%[1,22-4,71], arterial hypertension (OR=1,73; CI95%[1,06-2,85]), diabetes (OR=2,01; CI95%[1,17-3,45]), and dementia (OR=2,55; CI95%[1,12-5,79]). The group ≥ 76 years had more comorbidities with a median Charlson index of 5 (IQR: 4-7).
Based on these findings, two predictive models were developed: one incorporating specific comorbidities and the other using the Charlson Comorbidity Index. Both models showed good predictive accuracy, with area under the curve (AUC) values of 0.919 and 0.921 respectively. In comparison, the AUC values for ABSI and BUMP were 0.897 and 0.914 respectively.

Conclusion

This study confirms the significant impact of age and comorbidities on the mortality in burn patients. The results demonstrate that comorbidities such as cancer, hypertension, diabetes, and dementia are factors associated with mortality and should be considered when intensive resuscitation is required. The prognostic models developed in this study, incorporating these comorbidities, showed excellent predictive accuracy, outperforming existing scores. These models could therefore improve the assessment of mortality risk in burn patients and support the individualization of patient care based on individual risk profiles.

Auteurs

Chloe LACLIE (1) , Lucie GUILLEMET (1), Thaïs WALTER (1), Benjamin DENIAU (2), Emmanuel DUDOIGNON (1), Maxime COUTROT (1), Maïté CHAUSSARD (1), Alexandru CUPACIU (1), Alexandre PHARABOZ (1), Benoit PLAUD (1), François DEPRET (2), Louis BOUTIN (3) - (1)Department Of Anaesthesiology, Critical Care Medicine And Burn Unit, Ap-Hp, Saint-Louis Hospital, Dmu Parabol, Fhu Promice, Université De Paris,75010, Paris, France, (2)Inserm, Umr 942, Mascot: Cardiovascular Marker In Stress Condition, Lariboisière Hospital, Université De Paris,75010, Paris, France, (3)Department Of Anaesthesiology And Intensive Care, Hôpital Européen Georges Pompidou, Ap-Hp, 20 Rue Leblanc, 75015, Paris, France

Orateur(s)

Chloe LACLIE (Paris)