title: Factors affecting survival in adult patients with massive burns.
abstract: OBJECTIVE
  To identify treatment-related factors associated with mortality in massively burned adult patients.
  
  
  METHODS
  This retrospective cohort study examined survival outcomes at a burn unit of 54 beds and 10 burn ICU beds, totaling 900 admissions per year. The cases of 102 adult patients, admitted consecutively from January 1993 to October 2007, with massive burns (burn area>70% of the total body surface area, TBSA) were studied. Relevant variables were recorded from the initial injury and throughout the hospital course. Survival analysis, based on univariate and stepwise multivariate Cox proportional hazards regression, was performed to determine which variables predicted mortality.
  
  
  RESULTS
  The overall mortality rate was 30.4%. Burn size, severe inhalation injury, full-thickness burns, serum creatinine levels, inotropic support, platelet counts<20,000 per mm3, sepsis and ventilator dependency were significantly associated with mortality as determined by univariate analysis. Only sepsis, ventilator dependency and platelet counts were significant independent predictors of mortality as determined by multivariate analysis.
  
  
  CONCLUSIONS
  Sepsis, ventilator dependence (indicating severe respiratory complications), and low platelet counts (indicating thrombocytopenia) are associated with increased mortality risk in adult patients with massive burns. Methods should be sought to ameliorate these complications during treatment in burn-care units.
authors.affiliation: Department of Burn Surgery, Changhai Hospital, the Second Military Medical University, 174# Changhai Road, Shanghai 200433, China.
authors.forename: Yu
authors.initials: Y
authors.lastname: Wang
authors.forename: Hong-Tai
authors.initials: HT
authors.lastname: Tang
authors.forename: Zhao-Fan
authors.initials: ZF
authors.lastname: Xia
authors.forename: Shi-Hui
authors.initials: SH
authors.lastname: Zhu
authors.forename: Bing
authors.initials: B
authors.lastname: Ma
authors.forename: Wei
authors.initials: W
authors.lastname: Wei
authors.forename: Yu
authors.initials: Y
authors.lastname: Sun
authors.forename: Kai-Yang
authors.initials: KY
authors.lastname: Lv
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood; D001830:Body Surface Area; D002053:Burn Units; D002056:Burns / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy; D002316:Cardiotonic Agents / Q000627:therapeutic use; D003404:Creatinine / Q000097:blood; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D011379:Prognosis; D012121:Respiration, Artificial; D018805:Sepsis / Q000209:etiology; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D015415:Biomarkers; D002316:Cardiotonic Agents; D003404:Creatinine