Efficacy Of Hemodialysis Versus Non-hemodialysis Treatment In Patients With Severe Burns Complicated By Sepsis

Background & Objection:Patients with severe burns are at high risk of developing systemic infections that progress to life-threatening sepsis,and even multi-organ failure and septic shock.Effective treatment strategies for patients with sepsis due to burn infection are still limited,with a lack of targeted cures and poor prognosis.The relationship between the use of continuous blood purification and mortality in septic patients with co-infected burns remains controversial in the existing treatment protocols for burn infections and the latest recommended treatment for sepsis.The aim of this study was to analyse risk factors in patients with sepsis due to severe burn infections in our medical centre;to evaluate the impact of the use of CBP techniques on sepsis-related mortality in patients with severe burns relative to conventional treatment groups;and to observe changes in condition,biochemical parameters,altered levels of several inflammatory cytokines in the blood circulation and clinical outcomes.Methods:Retrospective analysis of patients with severe burns who met the diagnostic and nadir criteria at our Burn Plastic and Trauma Restoration Medicine Centre from January 2018 to December 2022.Patients were divided into survival and mortality groups based on 28-day survival,surveyed,and basic patient characteristic data,severity scores and peripheral circulating immune cell counts were collected and analysed.The relationship between the data collected and 28-day survival was assessed using a COX proportional etiology-specific risk model.ROC curves were used to investigate the predictive value of independent predictors for patients with burn sepsis.Enrolled patients were then divided into a CBP and control group according to treatment modality.Changes in risk factor indicators related to poor prognosis were collected and analysed before treatment(confirmed sepsis)and 24 and 48 hours after treatment.Kaplan-Meier survival curves and subgroup analysis forest plots were constructed to assess the relationship between 28-day survival and the use of CBP or not.Results:(1)The study comprised a total of 191 patients who satisfied the requirements for having severe burns,137 of them lived for 28 days or longer,and a total of 71 patients advanced to septic shock.Patients in the death group were more seriously ill when they were admitted,while those in the survival group had somewhat larger TBSA,III°burn area,and the number of combined inhalation injuries(P < 0.05).In terms of severe burn score,the surviving group outperformed the death group(P <0.01).However,there was no statistically significant difference in how CBP was applied between the two groups(P > 0.05).(2)The comparison of circulating immune cell counts between the survival and death groups was statistically significant except for neutrophils(P > 0.05).The lymphocyte count increased gradually from day 1 to day 7 in the survival group,while it decreased and then increased in the death group.Platelet counts fell rapidly in both groups from day 1 to day 3,while after day 3 to day 7 platelet counts began to rise slowly in both groups,but rose faster in the survival group than in the death group(P < 0.01).And the higher the index of LPR and NLR,the greater the probability of death(P < 0.01).(3)After correction for potential confounders,TBSA,BI,mean arterial pressure,potassium,calcitoninogen and 7-day NLR were found to be independent predictors of 28-day mortality in patients with sepsis due to severe burns.(4)ROC curve analysis of the independent predictors in patients with burn sepsis showed AUC values of 0.659(95% CI,0.576 ～0.744)for TBSA,0.673(95% CI,0.584 ～ 0.762)for BI,0.597(95% CI,0.509 ～0.685)for potassium,and 0.957(95% CI,0.957)for calcitoninogen.(95% CI,0.927～ 0.986).The Jorden index was greatest when the TBSA was taken as 72.5,with a sensitivity of 66.11% and specificity of 67.88%.(5)There was no statistical difference between the general condition of the CBP group and the conventional group,but in terms of TBSA and III° burn area,the severity of patients in the CBP group was higher than those in the conventional treatment group(P < 0.01).All observed indicators improved significantly after CBP treatment compared to before(P<0.05);also compared to the conventional group,after 48 hours of continuous CBP treatment,the efficacy of all observed indicators was more significant in each group except for blood calcium(P<0.05).(6)The effect of both treatments on the primary outcome indicator,28-day survival,was not significant(P = 0.341).In contrast,the Kaplan-Meier survival curve showed that the difference between the two treatment groups and 28-day survival after grouping by the cut-off value obtained for TBSA in the ROC curve remained unsuggestive of significance(P = 0.056).However,the CBP group significantly reduced the incidence of septic shock(P<0.05).Subgroup analysis suggested that deterioration to septic shock significantly affected patient survival(P<0.001),but CBP combined with the use of 12 cytokine tests improved patient survival(P<0.05).Conclusion:(1)CBP is one of the important measures in the treatment of severe burns combined with sepsis,which can rapidly improve abnormal indicators,alleviate the deterioration to septic shock and shorten the length of BICU stay of patients.(2)CBP treatment was more effective in patients with large(>72% TBSA)extra-severe burns,but did not improve the outcome prognosis of patients in this study compared with conventional medical treatment without CBP.(3)Monitoring NLR and LPR may assist in determining the prognosis of patients with severe burns combined with sepsis,and detection of NLR at day 7 was an independent risk factor for fatal events in patients with severe burns combined with sepsis.(4)Patients who maintain low levels of NLR and LPR indicators have a higher survival rate.Treatment with CBP can reduce the high values of both more rapidly.