Natalie Nguyen , Colette Galet , Alexander Kurjatko , Patrick W. McGonagill
{"title":"Admission lymphopenia predicts risk of pneumonia and AKI in hospitalized burn injuries","authors":"Natalie Nguyen , Colette Galet , Alexander Kurjatko , Patrick W. McGonagill","doi":"10.1016/j.burns.2025.107581","DOIUrl":null,"url":null,"abstract":"<div><div>Burn patients are at high risk for infectious complications due to immune dysregulation. This study investigated the relationship between admission lymphopenia (absolute lymphocyte count [ALC] < 1000) and burn injury outcomes. We hypothesized that lymphopenia would be associated with poor outcomes. This is a retrospective cohort study of all adult patients admitted from January 2017 to March 2023 for burn and/or inhalation injuries. Patients who died within 24 h were excluded. Demographics, comorbidities, ALC on admission, frailty status, admission and injury details including total burn surface area (TBSA), 2nd and 3rd degree TBSA, immunodeficient state, hospital course, surgical interventions, burn-specific and non-burn-specific complications, in-hospital mortality, and discharge disposition were collected. Univariate and multivariate analyses were performed to identify variables, including lymphopenia, associated with outcomes. P < 0.05 was considered significant. Of 286 eligible patients, 62 (21.7 %) were lymphopenic on admission. The cohort was predominantly male and white. Lymphopenic patients were older (64.5 y vs. 48 y, p < 0.001) and more likely to be frail (21 % vs. 4 %, p < 0.001). Immune-insufficient state, injury characteristics, hospital length of stay (LOS), LOS/TBSA, ventilator days, skin graft requirements, or in-hospital mortality were not significantly different between the groups. Adjusting for age, gender, frailty, inhalation injury, comorbidities, and %TBSA, lymphopenia was associated with increased risks of developing pneumonia (OR = 4.28 [1.19–15.47], p = 0.026) and AKI (3.90 [1.41–10.77], p = 0.009). Early identification of patients with higher risk for complications is imperative in burn management.</div></div>","PeriodicalId":50717,"journal":{"name":"Burns","volume":"51 7","pages":"Article 107581"},"PeriodicalIF":2.9000,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Burns","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0305417925002104","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CRITICAL CARE MEDICINE","Score":null,"Total":0}
引用次数: 0
Abstract
Burn patients are at high risk for infectious complications due to immune dysregulation. This study investigated the relationship between admission lymphopenia (absolute lymphocyte count [ALC] < 1000) and burn injury outcomes. We hypothesized that lymphopenia would be associated with poor outcomes. This is a retrospective cohort study of all adult patients admitted from January 2017 to March 2023 for burn and/or inhalation injuries. Patients who died within 24 h were excluded. Demographics, comorbidities, ALC on admission, frailty status, admission and injury details including total burn surface area (TBSA), 2nd and 3rd degree TBSA, immunodeficient state, hospital course, surgical interventions, burn-specific and non-burn-specific complications, in-hospital mortality, and discharge disposition were collected. Univariate and multivariate analyses were performed to identify variables, including lymphopenia, associated with outcomes. P < 0.05 was considered significant. Of 286 eligible patients, 62 (21.7 %) were lymphopenic on admission. The cohort was predominantly male and white. Lymphopenic patients were older (64.5 y vs. 48 y, p < 0.001) and more likely to be frail (21 % vs. 4 %, p < 0.001). Immune-insufficient state, injury characteristics, hospital length of stay (LOS), LOS/TBSA, ventilator days, skin graft requirements, or in-hospital mortality were not significantly different between the groups. Adjusting for age, gender, frailty, inhalation injury, comorbidities, and %TBSA, lymphopenia was associated with increased risks of developing pneumonia (OR = 4.28 [1.19–15.47], p = 0.026) and AKI (3.90 [1.41–10.77], p = 0.009). Early identification of patients with higher risk for complications is imperative in burn management.
期刊介绍:
Burns aims to foster the exchange of information among all engaged in preventing and treating the effects of burns. The journal focuses on clinical, scientific and social aspects of these injuries and covers the prevention of the injury, the epidemiology of such injuries and all aspects of treatment including development of new techniques and technologies and verification of existing ones. Regular features include clinical and scientific papers, state of the art reviews and descriptions of burn-care in practice.
Topics covered by Burns include: the effects of smoke on man and animals, their tissues and cells; the responses to and treatment of patients and animals with chemical injuries to the skin; the biological and clinical effects of cold injuries; surgical techniques which are, or may be relevant to the treatment of burned patients during the acute or reconstructive phase following injury; well controlled laboratory studies of the effectiveness of anti-microbial agents on infection and new materials on scarring and healing; inflammatory responses to injury, effectiveness of related agents and other compounds used to modify the physiological and cellular responses to the injury; experimental studies of burns and the outcome of burn wound healing; regenerative medicine concerning the skin.