Prognostic Significance of the Serum Creatinine Level During the Shock Stage in Severe Burn Patients: A 10-Year Retrospective Study.

Abstract

Objective: To evaluate the significance of serum creatinine (Scr) level during the shock stage as a prognostic indicator for 90-day mortality in severe burn patients. Methods: This retrospective cohort study included 224 severe burn patients with a burn ≥50% total body surface area (TBSA) admitted to the First Affiliated Hospital of Army Medical University from January 1, 2014, to December 31, 2023. Patient demography, the burn severity, infection markers, protein levels, renal function indicators, and prognostic indicators, including the hospital 90-day mortality rate, were collected. The comparisons of these indicators between the survival and death groups were performed by means of the independent-samples Mann-Whitney U test and chi-square test. Then the significantly different indicators between the two groups were subjected to univariate and multivariate logistic regression analyses. The independent risk factors affecting the prognosis of severe burn patients during the shock stage were screened, and a nomogram for the prediction of the survival rate of severe burn patients was constructed using the indicators in the shock stage. A receiver operating characteristic (ROC) curve was drawn to obtain the corresponding cut-off value. Differences between the two groups of patients separated according to the cut-off value were analyzed. The difference between the survival rate of both groups of patients during hospitalization was analyzed using the Kaplan-Meier(K-M) curve. Results: The survival rate was 183/224 with total length of stay (LOS) in hospital of 66 days (27-113). The differences in TBSA, burn index (BI), infection indicators (leukocytes, C-reactive protein [CRP], and procalcitonin [PCT]), and renal function indicators (Scr, blood urea nitrogen [BUN], and cystatin C [CysC]) between the survival group and the death group were significant (p  < 0.05). Logistic regression analysis revealed that the Scr level during the shock stage was an independent risk factor for the prognosis of the risk of death in severe burn patients with a cut-off value of 100 μmol/L. Compared with the low-Scr group (Scr < 100 μmol/L), the high-Scr group (Scr ≥ 100 μmol/L) had a larger TBSA and higher BI. The Scr level was positively correlated with the increase in the TBSA and BI. The development of persistent organ dysfunction (POD) and mortality in the high-Scr group was significantly greater than those in the low-Scr group. Conclusion: The Scr level during the shock stage is an independent risk factor for hospital death, which is important for the prognosis of the 90-days' mortality of severe burn patients, in combination with patient age, TBSA, and BI.