Importance of risk factors in the development of complications of infectious and inflammatory genesis in patients with severe burns

Abstract

Introduction. Infectious and inflammatory complications , such as pneumonia and burn sepsis, often develop in patients with extensive burns, thus causing high mortality.

         The aim of the work was to determine the risk factors for the development of infectious and inflammatory complications in patients with burns.

         Materials and methods. The study involved 140 burned patients divided into two groups: Group 1 – 78 patients who underwent necrectomy within 3-7 days after the burn, Group 2  (control) – 62 patients with necrectomy performed in later period.

         Results of the research. In the 1st group pneumonia was diagnosed in 11 (14.10 ± 3.94%) patients, sepsis – in 13 (16.67 ± 4.22%). In the control group pneumonia was diagnosed in 20 (32.26 ± 5.94%) patients, sepsis – in 23 (37.10 ± 6.13%) (p < 0.05). In the burned patients of the main group the development of infectious and inflammatory complications was observed mainly in patients over 45 years of age (43%), that is 2.9 times more often than in the patients of younger age (p < 0.05). In patients with the severity index of burn damage exceeding 90 units complications were diagnosed in 32.14 ± 6.24% of cases, which is 7 times more than in the other subgroup (p < 0.05). In the control group patients with the severity index of destruction exceeding 90 units had complications in 56.41 ± 7.94% of cases, which is 2.6 times more than in patients with less severity index (p = 0.004). If the total area of the skin burns was over 40%, the number of sepsis and pneumonia complications significantly increased in both groups, and was 1.7 times greater than in patients with a smaller area of the burn. If the area of deep skin burns was over 25%, the number of cases of pneumonia and sepsis in patients of the main group increased in 2.4 times, and in the control group it was in 1.6 times higher. Among patients with area of deep burns exceeding 40% the incidence of sepsis and pneumonia was 78% (p = 0.03) in the main group, and 100% (p = 0.005) in the control group. In patients of the main group who had severe burns of the respiratory tract  infectious and septic complications were found in 40.0 ± 21.91% of cases, while in the control group such complications were observed in 60.0 ± 21.91% of patients. In the main group 9 people died (11.54 ± 3.62%), and in the control group there were 20 deaths (32.26 ± 5.94%), which makes statistically significant 64.23% (p = 0,003) lower mortality in the main group. Of 9 death in the main group pneumonia was diagnosed in 44.44% (4 patients), septicemia in 89% (8 persons), and in the control group of 20 patients who died pneumonia was found in 75% (15 patients) and sepsis in 90% (18 people).

 Conclusions. In patients with severe burns complications of infectious and inflammatory origin, such as pneumonia and sepsis, are of the greatest importance and significantly affect the level of mortality. The leading risk factors for infectious and inflammatory complications in patients with severe burns are the total area of skin burns exceeding 40%, the area of deep burns exceeding 25% of the body surface, age over 45 years, severe burn of the respiratory tract, severity index of the burn damage exceeding 90 conventional units. Early surgical treatment, such as necrectomy performed within 3-7 days after the burn and aimed at removing necrotic tissue and providing adequate drainage of extensive burn wounds, greatly reduce the risk of infectious and septic complications.

Key words:burns, risk factors, complications infectious-inflammatory genesis.