Clinical outcomes following burn injury across the continuum of chronic glycemic control
| Autor: | Rebecca Coffey, Kyle Porter, Charles Zhang, Richard V Zhelezny, Claire V. Murphy |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Adult
Blood Glucose Burn injury medicine.medical_specialty Glycemic Control Critical Care and Intensive Care Medicine Amputation Surgical Prediabetic State 030207 dermatology & venereal diseases 03 medical and health sciences 0302 clinical medicine Internal medicine Diabetes mellitus medicine Diabetes Mellitus Humans Prediabetes Glycemic Retrospective Studies Past medical history business.industry 030208 emergency & critical care medicine General Medicine Length of Stay medicine.disease Propensity score matching Emergency Medicine Surgery business Burns Total body surface area Cohort study |
| Zdroj: | Burns : journal of the International Society for Burn Injuries. 47(5) |
| ISSN: | 1879-1409 |
| Popis: | Diabetes has been associated with poor outcomes following burn injury. There is limited data related to prediabetes in burn injury, and no studies to date have compared clinical outcomes inpatients without diabetes, with prediabetes, and with diabetes. Therefore, this study aimed to compare clinical outcomes after burn injury across the continuum of pre-injury glucose control. A propensity score weighted cohort study of adult patients admitted for initial management of burn injury was performed. Patients were categorized as no diabetes, prediabetes or diabetes based on their admission hemoglobin A1c and past medical history. The primary outcome was length of stay per percent Total Body Surface Area (TBSA) burn. Secondary outcome measures included length of stay, all-cause hospital mortality, disposition at discharge, re-grafting of same site, and amputations. A total of 2450 patients were screened; 1137 patients were included for evaluation (236 diabetes, 191 prediabetes, 710 no diabetes). After inverse probability weighing to adjust for potentially confounding factors, patients in the diabetes group had longer length of stay/%TBSA burn than both the no diabetes group (ratio of geometric means (95% CI) = 1.65 (1.25, 2.18), p0.001) and the prediabetes group (ratio (95% CI) = 1.49 (1.10, 2.02), p = 0.01). No statistically significant differences in secondary outcomes were observed between groups other than a higher rate of amputations in the diabetes group (2.7%) compared to the no diabetes (0.7%, p = 0.047) and prediabetes (0%, p = 0.04) groups. Further studies are needed to delineate the differences across the continuum of pre-injury glucose control in order to identify mechanisms to optimize burn-related outcomes. |
| Databáze: | OpenAIRE |
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