Citation

Paratz JD, Warren J, Paratz E, Watt K, Corte-Real V, Muller MJ, Cameron CM. J. Trauma Acute Care Surg. 2022; ePub(ePub): ePub.

Copyright

(Copyright © 2022, Lippincott Williams and Wilkins)

DOI

10.1097/TA.0000000000003781

PMID

36045492

Abstract

BACKGROUND: Burn injury is responsible for both acute and ongoing inflammation, resulting in systematic changes impacting the cardiovascular, hepatobiliary, endocrine and metabolic systems but there is minimal investigation into long term clinical outcomes. This study aimed to investigate mortality due to cardiovascular causes long-term post burn injury.

METHODS: This was a retrospective cohort study linking a burns unit database with mortality outcomes from a Registry of Births, Deaths and Marriages. Data was extracted from the Australian Institute of Health and Welfare and stratified into three age groups: 15-44, 45-64 and 65+ years. Mortality Rate Ratios (MRR) and 95% CI were calculated to compare the burns cohort mortality incidence rates with the national mortality incidence rates the three age-groups. Logistic regression was used to identify demographic and clinical factors associated with cardiovascular mortality.

RESULTS: A total of 4134 individuals in the database were analysed according to demographic and clinical variables. The 20-year age-standardised cardiovascular mortality rate for the burns cohort was significantly higher compared to the Australian population (250.6 per 100,000 person-years (PYs) v 207.9 per 100,000 PYs) (MRR = 1.21, 95%CI 1.001-1.45). Cardiovascular mortality was significantly higher in males aged 15-44 and 45-64 years (respectively) in the burns cohort than in the age-matched Australian population (MRR = 8.48, 95%CI 3.47-13.49), and (MRR = 1.75, 95%CI 1.07-2.44) respectively. Those who died of cardiovascular disease were more frequently intubated post-burn injury (p = 0.01), admitted to intensive care (p < 0.0001), and had pre-existing comorbid physical conditions (60.9% v 15.0%, p < 0.0001).

CONCLUSION: Survivors from burn injury, especially young males are at increased long-term risk of death from cardiovascular disease. Increased screening and counselling pertaining to lifestyle factors should be standard management post burn injury. Longitudinal observation of physiological changes, investigation of mechanistic factors and investigation of interventional strategies should be instituted. LEVEL OF EVIDENCE: Retrospective cohort study Level IV. TYPE OF STUDY: Epidemiological.

Language: en