Fig 1 - uploaded by Monika Belba
Content may be subject to copyright.
Source publication
Background:
The aim of this prospective study in adult population is to give frequency data (prevalence, incidence) of burn wound sepsis and its consequences (organ dysfunction/failure); to analyze the evolution of the SOFA cumulative score during the disease and relationship between the SOFA score in the 3rd, 7th, 14th and 21th day after burn wit...
Context in source publication
Context 1
... them, based on clinical criteria of sepsis, we observed in total 203 patients (4 deaths) without sepsis and 90 patients (31 deaths) with sepsis. The way we have analyzed our data is described in the patient selection, flow chart (Fig. 1). The patients were grouped according to the length of hospital stay (LOS) in four groups. In group 1 there were 78 patients with LOS 3-6 days; in Group 2 there were 110 patients with LOS 7-13 days; in Group 3 there were 41 patients with LOS 14-20 days and in Group 4 remained 64 patients with LOS more than 21 ...
Similar publications
Sepsis in intensive care units (ICUs) represent a threat with need for rapid and accurate diagnosis. We aimed to assess miR-122 as an early biomarker for diagnosis and outcome prediction in patients with hospital acquired sepsis in ICU. This case control study included 25 adults' patients with sepsis and 25 patients with local wound infections as a...
Citations
... The prevalence of sepsis in burn patients ranges from 26% to 65%. 21,86,87 The first line of defense of the innate immune system against pathogens is the anatomical barrier of the skin and mucosal epithelium before antigen-presenting cells and complement, but burns are reported to cause not only loss of the skin barrier but also damage to the intestinal epithelium. 88,89 In addition to disruption of the anatomic barrier, the combination of excessive inflammation and immunosuppression caused by DAMPs increases the mortality rate of sepsis in patients with severe burns. ...
Immune responses that occur following burn injury comprise a series of reactions that are activated in response to damaged autologous tissues, followed by removal of damaged tissues and foreign pathogens such as invading bacteria, and tissue repair. These immune responses are considered to be programmed in living organisms. Developments of modern medicine have led to the saving of burned patients who could not be cured previously; however, the programmed response is no longer able to keep up, and various problems have arisen. This paper describes the mechanism of immune response specific to burn injury and the emerging concept of persistent inflammation, immunosuppression, and catabolism syndrome.
... For burns above 20% of the body surface, in addition to the rupture of the protective skin barrier, humoral and cellular immunity are also altered, making preventing and treating infection more difficult [123]. A prospective cohort study conducted with adult burn patients admitted to an ICU observed a 26% prevalence of sepsis, overall mortality of 11.9%, and 34.4% in patients with sepsis [124], indicating the importance that this type of complication has in the final result obtained and, therefore, the need to monitor these events for better quality care. ...
Background
Burn treatments are complex, and for this reason, a specialised multidisciplinary approach is recommended. Evaluating the quality of care provided to acute burn patients through quality indicators makes it possible to develop and implement measures aiming at better results. There is a lack of information on which indicators to evaluate care in burn patients. The purpose of this scoping review was to identify a list of quality indicators used to evaluate the quality of hospital care provided to acute burn patients and indicate possible aspects of care that do not have specific indicators in the literature.
Method
A comprehensive scoping review (PRISMA-ScR) was conducted in four databases (PubMed, Cochrane Library, Embase, and Lilacs/VHL) between July 25 and 30, 2022 and redone on October 6, 2022. Potentially relevant articles were evaluated for eligibility. General data and the identified quality indicators were collected for each included article. Each indicator was classified as a structure, process, or outcome indicator.
Results
A total of 1548 studies were identified, 82 were included, and their reference lists were searched, adding 19 more publications. Thus, data were collected from 101 studies. This review identified eight structure quality indicators, 72 process indicators, and 19 outcome indicators listed and subdivided according to their objectives.
Conclusion
This study obtained a list of quality indicators already used to monitor and evaluate the hospital care of acute burn patients. These indicators may be useful for further research or implementation in quality improvement programs.
Trial Registration
Protocol was registered on the Open Science Framework platform on June 27, 2022 (https://doi.org/10.17605/OSF.IO/NAW85).
... Reviewing the literature, several studies showed a prevalence of sepsis in burn patients varying from 26% [45] to 50.6% [46], 54% [47], or 65.5% [48]. This variation is influenced by factors such as the age and severity of burns within the study groups, as well as the definition used for sepsis [49]. ...
... Risk factors for sepsis were identified as follows: old age, TBSA > 20%, inhalation injury, male gender, and presence of comorbidities (cancer, immunosuppression, diabetes, liver disease, and kidney disease) [46,47,50]. While the overall mortality rate is consistently decreasing, the mortality of burn patients who develop sepsis remains around 34.4%, emphasizing the significance of addressing this issue to improve the overall outcomes of burn patients [45]. ...
Background and objectives: Burn injuries are the most severe type of trauma, with complex biological consequences associated with high rates of morbidity and mortality. Prompt recognition and management of burn-related complications are imperative for improving the vital and functional prognosis of the patient. Changes in biological parameters can be essential determinants in the prognosis of the burned patient. Thrombocytopenia in critically ill patients is linked to an elevated risk of mortality. We sought to investigate the significance of thrombocytopenia in severely burned patients while considering the limited available data in the literature. Materials and methods: A two-year retrospective study was conducted on 90 patients with severe burns admitted to our Burn Centre. Demographic data, burn lesion characteristics, and daily total blood counts, including platelet assessment, complications, and mortality, were recorded and analyzed. Results: Patients with extensive burns in our study had a poor prognosis based on their Abbreviated Burn Severity Index score (ABSI), age, percentage of total body surface area (TBSA) burned, presence of third-degree burns, and inhalation injuries. Regardless of the moment, patients with thrombocytopenia in our study died significantly more frequently. Compared with the survivors, the platelet count was significantly lower at any given time in the non-survivors group. Significant statistical associations between thrombocytopenia and ABSI score, burn surface area, presence of third-degree burns, and inhalation injuries were identified at different timeframes post-burn injury. Sepsis was encountered in one-third of the patients. Thrombocytopenia was more frequent in patients with sepsis who did not survive compared to survivors and did not normalize until the time of death. Conclusions: Thrombocytopenia represents an early indicator of severe complications and outcome predictor in severely burned patients. It is correlated with recognized negative prognostic factors and also with sepsis occurrence. Future research efforts should focus on refining early detection parameters and interventions to improve the prognosis of burn patients.
... As sepsis remains the leading cause of death after burn injury, it is imperative we find the most effective means of early identification of sepsis. Organ function deterioration has proved remarkably predictive of mortality [38,41,42] [44]. In burn patients, the signs and symptoms may be subtle or profound and are often inconsistent between different patients. ...
... Despite the widespread use of antibiotics and advanced supportive care, infectious complications are now the main cause of death in patients with severe burns. Previous studies have shown that 34-65% of deaths in burn patients are attributed to infectious complications or sepsis [1,[3][4][5]. The mortality rates in septic burn patients associated with infectious complications remain high, and fighting such infections is a real challenge [3]. ...
... Previous studies have shown that 34-65% of deaths in burn patients are attributed to infectious complications or sepsis [1,[3][4][5]. The mortality rates in septic burn patients associated with infectious complications remain high, and fighting such infections is a real challenge [3]. With the growing threat of multidrug-resistant pathogens in burn injuries [1], new strategies, apart from antibiotic therapy, are required to prevent or treat these infections. ...
Infectious complications and subsequent sepsis in severely burned patients lead to high morbidity and mortality in response to uncontrolled innate immune responses mediated by macrophages. Peroxisome proliferator-activated receptor gamma (PPARγ) has anti-inflammatory activity and acts as a master regulator of macrophage polarization. In this study, we investigated whether the administration of a PPARγ agonist could modulate the Kupffer cell phenotype and thereby ameliorate the dysregulated innate response during post-burn bacterial infection. C57BL/6 mice were subjected to severe burns and randomized to receive either the PPARγ agonist, pioglitazone, or the vehicle control five days after injury, followed by the subsequent analysis of hepatic macrophages. Survival from the bacterial infection was monitored for seven days. Pioglitazone protected burned mice against bacterial infection. A single treatment with pioglitazone significantly enhanced phagocytosis, phagosome acidification, bacterial clearance, and reduction in inflammatory mediators in Kupffer cells. In conclusion, PPARγ activation by pioglitazone prevents clinical deterioration due to post-burn bacterial infection and improves survival. Our findings suggest that pioglitazone may be an effective therapeutic candidate for post-burn infectious complications.
... Compared with previous studies, the incidence of sepsis in our study was relatively low. Previous studies have shown that the incidence of sepsis varied among different populations (7,8,14,31,32). The disparity in the patient population might be the main reason for the difference in the incidence of sepsis. Differences in the definitions of sepsis could partly explain the variation in incidence. ...
Background
Data concerning the epidemiology of sepsis in critically ill post-craniotomy patients are scarce. This study aimed to assess the incidence, risk factors, and outcomes of sepsis in this population.
Methods
This was a single-center prospective cohort study. Post-craniotomy patients admitted to the intensive care unit (ICU) were screened daily for the presence of infection and sepsis.
Results
Of the 900 included patients, 300 developed sepsis. The cumulative incidence of sepsis was 33.3% [95% confidence interval (CI), 30.2–36.4%]. Advanced age, male, hypertension, trauma, postoperative intracranial complications, and lower Glasgow Coma Scale (GCS) on the first postoperative day were independent risk factors of sepsis. Septic patients had higher hospital mortality (13.7 vs. 8.3%, P = 0.012), longer ICU length of stay (LOS) (14 vs. 4 days, P < 0.001), longer hospital LOS (31 vs. 19 days, P < 0.001), and higher total medical cost (CNY 138,394 vs. 75,918, P < 0.001) than patients without sepsis.
Conclusion
Sepsis is a frequent complication in critically ill post-craniotomy patients. Advanced age, male, hypertension, trauma, postoperative intracranial complications, and lower GCS on the first postoperative day were independent risk factors of sepsis.
... SI and sepsis are caused predominantly by unresolved local infections that aggravate and become systemic, such as infections of the digestive system (gastroenteritis, colitis and appendicitis), airways (pneumonia) and renal system (pyelonephritis, cystitis, urethritis) (Alberti et al. 2002). Open wounds, such as severe burns, can also lead to pathogen invasion and sepsis (Belba et al. 2017). ...
Sepsis is a complex and severe pathological condition that is characterized by hyper-inflammation followed by leukocyte dysfunction and excessive tissue injury. The mechanisms controlling immune dysregulation remain poorly understood. In this thesis, we show that fungal capture in spleen promotes inflammation and DAMPs-mediated immune dysfunction during systemic candidiasis. We identify the molecules and cellular players and define the order of events that link immune dysfunction between lymphocytes and neutrophils. SIGNR1+ marginal zone macrophages (MZMΦs) capture Candida albicans (C. albicans) and enable fungal colonization of the spleen marginal zone (MZ), triggering aberrant lymphocyte death and release of cell-free chromatin, that synergizes with fungal hyphae to stimulate G-CSF production by CD169+ marginal metallophilic macrophages (MMMΦs). G-CSF and extracellular chromatin selectively reduce the lifespan of mature Ly6Ghigh neutrophils, leading to severe neutropenia. ROS-deficient immature Ly6Glow neutrophils are mobilised and become the predominant peripheral neutrophil population, causing impaired fungal clearance and severe pathology. SIGNR1-blockade effectively limits fungal colonization in the MZ and increases survival. Similarly, T cell- deficiency or neutralization of G-CSF, chromatin or histones consistently reduces inflammation, neutrophil dysfunction and pathology. The release of cell-free actin by dying splenocytes and tissue damage further enhances pathology by interfering with extracellular chromatin clearance. These findings demonstrate that PAMPs and DAMPs mediate inflammation and neutrophil dysregulation, causing a detrimental positive feedback-loop that impairs fungal clearance and increases sepsis pathology.
... Previous studies showed sepsis to be the cause of death in 50-60% of non-survivors [2][3][4]. In the literature, a wide range of sepsis prevalence, between 26% and 65%, is reported among burn patients depending on age and burn severity of the analyzed burn population and depending on the definition of "sepsis" [5][6][7]. Whereas the overall mortality is continuously decreasing for burn patients [8], the mortality of septic burn patients is still as high as 34% [7]. This underlines the importance of the topic for the patients' outcome in burn care. ...
... In the literature, a wide range of sepsis prevalence, between 26% and 65%, is reported among burn patients depending on age and burn severity of the analyzed burn population and depending on the definition of "sepsis" [5][6][7]. Whereas the overall mortality is continuously decreasing for burn patients [8], the mortality of septic burn patients is still as high as 34% [7]. This underlines the importance of the topic for the patients' outcome in burn care. ...
... In burn patients, the SOFA score has so far been analyzed in a few studies [7,46,47]. A retrospective study on 169 burn patients showed an excellent correlation of the SOFA score and mortality [47]. ...
After surviving the acute phase of resuscitation, septic shock is the cause of death in the majority of burn patients. Therefore, the management of septic shock is a cornerstone in modern burn care. Whereas sepsis therapy in general has undergone remarkable developments in the past decade, the management of septic shock in burn patients still has a long way to go. Instead, the differences of burn patients with septic shock versus general patients have been emphasized and thus, burn patients were excluded in every sepsis study which are the basis for modern sepsis therapy. However, due to the lack of evidence in burn patients, the standards of procedure for general sepsis therapy have been adopted in burn care. This review identifies the differences of burn patients with sepsis versus other septic patients and summarizes the scientific basis for modern sepsis therapy in general ICU patients and burn patients. Consequently, the results in general sepsis research should be transferred to burn care, which means the implementation of effective screening, early resuscitation, and efficient antimicrobial treatment. Therefore, on the basis of past developments and in the light of the current update of the Surviving Sepsis Campaign guidelines, this review introduces the “Burn SOFA score” and the “3 H’s of burn sepsis” as a screening tool for early sepsis recognition in burn patients.
... Many factors affect this progression including organism type, toxicity, TBSA and age [11,[18][19][20]. A recent study observed high mortality rates among septic burn patients reaching 34.4% [21]. Furthermore, a systematic review of mortality rates in sepsis reported higher mortality rates among burn patients compared to both trauma and other critically ill patients, reaching up to 65% [22]. ...
Burn wound colonization can progress to invasive infection. During 14 years of this study, the burn center was relocated to a center with improved infrastructure. This study investigates the association that infrastructure, geography and time may have on colonization. Data were collected Oct-2004 to Aug-2018, relocation took place June-2010, defining the two study periods. Admission swabs were within 48 hours. Unique isolates and resistance data were analyzed and compared statistically between two study periods. 2,001 patients with 24,226 wound swabs were included. Median age 45.4 [IQR30.2-61.6], length of stay 11 days [IQR6-21] and %TBSA 5.5 [IQR2.5-11]. Staph. aureus (33.7/100 patients) and Pseudomonas spp. (13.1/100 patients) were the most prevalent bacterial growths. After admission, prevalence of MRSA, coliform spp. and Aci. baumanni were greater in first site, candida spp. colonization was higher in the second study period site. Prevalence of patients affected by multi-drug resistant organisms was lower in the second study site, 13.5/100 patients vs 16.6/100 patients, p<0.05. There are differences in burn wound colonization across time, within the same region. Candidal spp. growth has been shown to be increased over time and represents an added challenge. Awareness facilitates effective empirical antimicrobial therapies and protocols locally.
... 2,3 Septic shock and multiple organ failure can develop rapidly from burn sepsis, which can lead to death. 4 Therefore, early detection of high-risk groups prone to burn sepsis, early diagnosis, and prediction of the prognosis of burn sepsis are key to reducing the mortality of patients with this condition. Bacterial blood culture is an important aspect of clinical etiological detection and diagnosis of burn sepsis, however blood culture does not enable a rapid diagnosis of burn sepsis, as it may take 3 days or more to produce a result. ...
Sepsis is one of the main causes of death in burn patients, and many studies have suggested that procalcitonin (PCT) is a biomarker for the early diagnosis of sepsis, but the results are controversial. The aim of this study was to evaluate the diagnostic value of serum PCT in adult burn sepsis by conducting a meta-analysis of published studies. The PubMed, Embase, Web of Science, CNKI and China Wanfang databases were searched, and studies on PCT as a marker for the diagnosis of adult burn sepsis from the establishment of the database, to February 1, 2020 were screened. The data were analyzed using Stata v. 15.0 software. A total of 10 studies and 704 patients were included. The combined sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR) and diagnostic odds ratio (DOR) were 0.67 (95% CI: 0.48-0.81), 0.87 (95% CI: 0.72-0.95), 5.20 (95% CI: 2.49-10.84), 0.38 (95% CI: 0.24-0.61) and 13.70 (95% CI: 5.72-32.82), respectively. The area under the summary receiver operating characteristic curve (SROC) was 0.85 (95% CI: 0.82-0.88), and the diagnostic threshold was the main source of heterogeneity. Results demonstrate that serum PCT may be used as a useful biomarker for the early diagnosis of burn sepsis in adults, and may be combined with other diagnostic indexes to further improve the sensitivity and specificity.
