THE SIGNIFICANCE OF LEVELS OF SERUM PROTEINS AND THEIR TRENDS AS PROGNOSTIC INDICATORS OF BURN MORTALITY

Dr Monali Makadia, Dr Devanshu kalra

Abstract


Introduction: In severe burns, there is a profound systemic response that persists till the wounds heal. Since these physiological and metabolic
derangements are dynamic over the clinical course of burns, it is expected that both trend of change and absolute values of the proteins, to have a
bearing on the prognosis and the ultimate outcome. Hence, this study evaluates the prognostic value of this metabolic variable in burn patients.
Materials and Methods: The study conducted on 100 adult patients of thermal burn (20% and 60% total body surface area). Serum albumin,
globulin and total proteins were estimated on alternate days starting from day of admission till discharge or death. The 1st-day value and the trend of
serial values throughout the clinical course were compared among expired and survivors. Results: Mean serum values of albumin, globulin, and
total protein on first-day of burns in survivor group were higher. Serum albumin levels of ≤2.1 g/dl at day one was a poor prognostic factor. The
trend in the serum values of albumin, globulin and total protein in survivor group was significantly positive and was negative in expired. Among the
biochemical markers evaluated, most significant prognostic parameter was serum albumin, with maximum sensitivity and specificity. Conclusion:
The cutoff values of proteins and trend of subsequent serial values can guide metabolic manipulations, albumin infusion, and dietary intake. In
addition, these biochemical parameters merit inclusion in burn prognostic index scales. Keywords: Albumin, burns, prognosis, total protein, trends


Full Text:

PDF

References


Burns. World Health Organization; 2017. Available from: http:// www.who.int/violence_injury_prevention/other_injury/burns/en/. [Last accessed on 2017 Jul 01].

Adiyanti SS, Loho T. Acute kidney injury (AKI) biomarker. Acta Med Indones 2012;44:246 55.

Tobiasen J, HiebertJM, Edlich RF. The abbreviated burn severity index. Ann Emerg Med 1982;11:260 2.

Clark CJ, Reid WH, Gilmour WH, Campbell D. Mortality probability in victims of fire trauma: Revised equation to include inhalation injury. Br Med J (Clin Res Ed) 1986;292:1303 5.

Godwin Y, Wood SH. Major burns in cape town: Amodified burns score for patient triage. Burns 1998;24:58 63.

Ryan CM, Schoenfeld DA, Thorpe WP, Sheridan RL, Cassem EH, Tompkins RG, et al. Objective estimates of the probability of death from burn injuries. N Engl J Med 1998;338:362 6.

Williams FN, Herndon DN, Jeschke MG. The hypermetabolic response to burn injury and interventions to modify this response. Clin Plast Surg 2009;36:583 96.

Hart DW, Wolf SE, Mlcak R, Chinkes DL, Ramzy PI, Obeng MK, et al. Persistence of muscle catabolism after severe burn. Surgery 2000;128:312 9.

Reiss E, Pearson E, Artz CP. The metabolic response to burns. J Clin Invest 1956;35:62 77.

Waxman K, Rebello T, Pinderski L, O’Neal K, Khan N, Tourangeau S, et al. Protein loss across burn wounds. J Trauma 1987;27:136 40.

Dickson PW, Bannister D, Schreiber G. Minor burns lead to major changes in synthesis rates of plasma proteins in the liver. J Trauma 1987;27:283 6.

Kim GH, Oh KH, Yoon JW, Koo JW, Kim HJ, Chae DW, et al. Impact of burn size and initial serum albumin level on acute renal failure occurring in major burn. Am J Nephrol 2003;23:55 60.

Carlson A, Lars A, Sten Otto L. Lipid metabolism and trauma. Acta Medica Scand 2009;173:25 34.

Coombes EJ, Shakespeare PG, Batstone GF. Lipoprotein changes after burn injury in man. J Trauma 1980;20:971 5.

Kamolz LP, Andel H, Mittlböck M, Winter W, Haslik W, Meissl G, et al. Serum cholesterol and triglycerides: Potential role in mortality prediction. Burns 2003;29:810 5.

Goldwasser P, Feldman J. Association of serum albumin and mortality risk. J Clin Epidemiol 1997;50:693 703.

Jeschke MG, Barrow RE, Herndon DN. Extended hypermetabolic response of the liver in severely burned pediatric patients. Arch Surg 2004;139:641 7.

Aguayo Becerra OA, Torres Garibay C, Macías Amezcua MD, Fuentes Orozco C, Chávez Tostado Mde G, Andalón Dueñas E, et al. Serum albumin level as a risk factor for mortality in burn patients. Clinics (Sao Paulo) 2013;68:940 5.

Ramos GE, BolgianiA, Guastavino P, Prezzavento P, Patin˜ O, Benaim F. Hypoalbuminemia in burned patients: An outcome marker that could define evolution periods. Rev Arg Quem 2000;15:20 8.

Eljaiek R, Dubois MJ. Hypoalbuminemia in the first 24h of admission is associated with organ dysfunction in burned patients. Burns 2013;39:113 8.

Pérez Guisado J, de Haro Padilla JM, RiojaLF, DerosierLC, de la Torre JI. Serum albumin levels in burn people are associated to the total body surface burned and the length of hospital stay but not to the initiation of the oral/enteral nutrition. Int J Burns Trauma 2013;3:159 63.

Demling RH. The incidence and impact of pre existing protein energy malnutrition on outcome in the elderly burn patient population. J Burn Care Rehabil 2005;26:94 100.

Kumar P. Grading of severity of the condition in burn patients by serum protein and albumin/globulin studies. Ann Plast Surg 2010;65:74 9.

Alvarez C, Ramos A. Lipids, lipoproteins, and apoproteins in serum during infection. Clin Chem 1986;32:142 5.

Gui D, Spada PL, De Gaetano A, Pacelli F. Hypocholesterolemia and risk of death in the critically ill surgical patient. Intensive Care Med 1996;22:790 4.

Crook MA, Velauthar U, Moran L, Griffiths W. Hypocholesterolaemia in a hospital population. Ann Clin Biochem 1999;36(Pt 5):613 6.

Birke G, Carlson LA, Liljedahl SO. Lipid metabolism and trauma 3. Plasma lipids and lipoproteins in burns. Acta Med Scand 1965;178:337 50.

Birke G, Carlson LA, von Euler US, Liljedahl SO, Plantin LO. Studies on burns. XII. Lipid metabolism, catecholamine excretion, basal metabolic rate, and water loss during treatment of burns with warm dry air. Acta Chir Scand 1972;138:321 33.


Refbacks

  • There are currently no refbacks.