Differential benefits of steroid therapies in adults following major burn injury.

Autor: Altarrah K; Institute of Inflammation and Ageing, University of Birmingham, Birmingham B15 2TT, UK; Scar Free Foundation Centre for Conflict Wound Research, University Hospitals Birmingham, Birmingham B15 2WB, UK; Department of Burns and Plastic Surgery, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham Foundation Trust, Birmingham B15 2WB, UK. Electronic address: k.altarrah@bham.ac.uk., Tan P; Department of Burns and Plastic Surgery, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham Foundation Trust, Birmingham B15 2WB, UK., Acharjee A; Centre for Computational Biology, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham B15 2TT, UK; NIHR Surgical Reconstruction and Microbiology Research Centre, University Hospitals Birmingham, Birmingham B15 2WB, UK., Hazeldine J; Institute of Inflammation and Ageing, University of Birmingham, Birmingham B15 2TT, UK; NIHR Surgical Reconstruction and Microbiology Research Centre, University Hospitals Birmingham, Birmingham B15 2WB, UK., Torlinska B; Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK., Wilson Y; Department of Burns and Plastic Surgery, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham Foundation Trust, Birmingham B15 2WB, UK., Torlinski T; Department of Anaesthetics and Critical Care, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham Foundation Trust, Birmingham B15 2WB, UK., Moiemen N; Institute of Inflammation and Ageing, University of Birmingham, Birmingham B15 2TT, UK; Scar Free Foundation Centre for Conflict Wound Research, University Hospitals Birmingham, Birmingham B15 2WB, UK; Department of Burns and Plastic Surgery, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham Foundation Trust, Birmingham B15 2WB, UK., Lord JM; Institute of Inflammation and Ageing, University of Birmingham, Birmingham B15 2TT, UK; Scar Free Foundation Centre for Conflict Wound Research, University Hospitals Birmingham, Birmingham B15 2WB, UK; NIHR Surgical Reconstruction and Microbiology Research Centre, University Hospitals Birmingham, Birmingham B15 2WB, UK.
Jazyk: angličtina
Zdroj: Journal of plastic, reconstructive & aesthetic surgery : JPRAS [J Plast Reconstr Aesthet Surg] 2022 Aug; Vol. 75 (8), pp. 2616-2624. Date of Electronic Publication: 2022 Apr 20.
DOI: 10.1016/j.bjps.2022.04.007
Abstrakt: Background: Major thermal injury induces a complex pathophysiological state characterized by burn shock and hypercatabolism. Steroids are used to modulate these post-injury responses. However, the effects of steroids on acute post-burn outcomes remain unclear.
Methods: In this study of 52 thermally injured adult patients (median total burn surface area 42%, 33 males and 19 females), the effects of corticosteroid and oxandrolone on mortality, multi-organ failure (MOF), and sepsis were assessed individually. Clinical data were collected at days 1, 3, 7, and 14 post-injury.
Results: Twenty-two (42%) and 34 (65%) burns patients received corticosteroids and oxandrolone within the same cohort, respectively. Following separate analysis for each steroid, corticosteroid use was associated with increased odds of in-hospital mortality (OR 3.25, 95% CI: 1.32-8•00), MOF (OR 2.36, 95% CI: 1.00-1.55), and sepsis (OR 5.95, 95% CI: 2.53-14.00). Days alive (HR 0.32, 95% CI: 0.18-0.60) and sepsis-free days (HR 0.54, 95% CI: 0.37-0.80) were lower among corticosteroid-treated patients. Oxandrolone use was associated with reduced odds of 28-day mortality (OR 0.11, 95% CI: 0.04-0.30), in-hospital mortality (OR 0.19, 95% CI: 0.08-0.43), and sepsis (OR 0.24, 95% CI: 0.08-0.69). Days alive, at 28 days (HR 6.42, 95% CI: 2.77-14.9) and in-hospital (HR 3.30, 95% CI: 1.93-5.63), were higher among the oxandrolone-treated group. However, oxandrolone was associated with increased MOF odds (OR 7.90, 95% CI: 2.89-21.60) and reduced MOF-free days (HR 0.23, 95% CI: 0.11-0.50).
Conclusion: Steroid therapies following major thermal injury may significantly affect patient prognosis. Oxandrolone was associated with better outcomes except for MOF. Adverse effects of corticosteroids and oxandrolone should be considered when managing burn patients.
Competing Interests: Declaration of Competing Interest The authors declare no competing interests.
(Copyright © 2022 Elsevier Ltd. All rights reserved.)
Databáze: MEDLINE
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