S. J. Day1, D. E. Bell1 1University Of Rochester,School Of Medicine And Dentistry,Rochester, NY, USA
Introduction: Low prealbumin levels in burn patients at admission is an indicator of poor baseline nutrition status, which can negatively influence wound healing. This study aimed to identify the role of prealbumin and C-reactive protein (CRP) levels in predicting clinical outcomes of burn injuries.
Methods: Retrospective case review was conducted of burn patients admitted to an American Burn Association-verified regional burn center from July 2015 to December 2015. Demographic, injury-related and hospitalization-related variables were assessed for correlation with prealbumin and C-reactive protein (CRP) levels collected within 48 hours of admission. Patients were stratified by normal (≥ 20 mg/dL) or low-normal (< 20 mg/dL) prealbumin levels at admission, and normal (≤ 10 mg/dL) or high (> 10 mg/dL) CRP levels at admission.
Results:
From July 2015 to December 2015, 131 burn patients were admitted to a regional burn center (69.5% male; mean age, 32 years). Average TBSA burned was 5.17% (range 0.03 – 25.37%), with average 2nd degree burn size of 4.42% TBSA and 3rd degree burn size of 0.77% TBSA.
Patients in the two groups of normal (58 patients, 44.3%) vs low-normal (50 patients, 38.2%) prealbumin at admission were matched in age, sex, and TBSA. Compared to patients with normal prealbumin levels, patients with prealbumin < 20mg/dL had longer length of hospital stay (13 days vs 8 days, p < 0.05). Patients admitted with prealbumin < 20mg/dL also had significantly improved prealbumin at discharge (15.52 vs 18.91, p = 0.005). Low-normal prealbumin at admission was associated with higher CRP levels (p < 0.0001).
The two groups of normal (56 patients, 42.7%) vs high (36 patients, 27.4%) CRP at admission were matched in sex and TBSA but significantly different in age (30 vs 44 years, p = 0.002). Therefore, we controlled for age by stratifying patients into those ≤ 40 years old, and those older than 40 years. After stratification, we found that in patients ≤ 40 years old, high CRP at admission was associated with longer duration of mechanical ventilation (1.85 days vs 0 days, p < 0.05) and increased hospital cost ($82,079 vs $27,701, p < 0.05). In patients older than 40 years, CRP level at admission was not statistically related to length of stay, hospital cost, or days of mechanical ventilation.
Conclusion: Low prealbumin at admission is predictive of longer length of hospital stay in burn patients of all ages, as age was matched between the normal and low-normal prealbumin groups in our study. In patients 40 years or older, elevated CRP is associated with longer duration of mechanical ventilation and increased hospital cost. Thus, prealbumin and CRP levels at admission should be incorporated into prognostic calculations of burn injury outcomes.