Division of Plastic & Reconstructive Surgery, Department of Surgery, Stanford University, California.
Division of Trauma, Burn, & Critical Care Surgery, Department of Surgery, University of Washington, Seattle.
J Burn Care Res. 2020 Sep 23;41(5):956-962. doi: 10.1093/jbcr/iraa090.
Preburn comorbidities increase the risk of death in the acute phase, and negatively impact quality of life among survivors. Investigations to date have only evaluated comorbidities as indices, limiting the ability to target conditions and develop strategies for risk reduction. Therefore, we aimed to evaluate the differential effects of specific conditions on long-term, patient-reported outcomes after burn injury. A prospectively maintained trauma registry was merged with a longitudinal database of patient-reported outcomes from a regional burn center from 2007 to 2018. Demographic data, injury-specific information, and the prevalence of 20 comorbidities were systematically documented. The impact of comorbidities on responses to Short Form-12/Veterans RAND 12 (SF/VR-12) health surveys at 6, 12, and 24 months postinjury was evaluated with generalized linear models. The merged dataset included 493 adult participants. Median age was 46 years (interquartile range, IQR 32-57 years), and 72% were male. Median burn size was 14% TBSA (IQR 5-28%). Seventy percent of participants had ≥1 comorbidity (median 1 comorbidity/participant; IQR 0-2 comorbidities). SF/VR-12 mental component summary scores at 6 and 12 months postinjury were negatively associated with mental illness (P < .001, P = .013). SF/VR-12 physical component summary (PCS) scores were negatively associated with smoking (P = .019), diabetes (P = .001), and alcohol use disorder (P = .001) at 6-month follow-up. Twelve-month SF/VR-12 PCS scores were negatively associated with prior trauma admission (P = .001) and diabetes (P = .042). Twenty-four-month SF/VR-12 PCS scores were negatively associated with mental illness (P = .003). Smoking, alcohol use disorder, and diabetes were associated with lower PCS scores 6 months after injury; diabetes persisted as a negatively associated covariate at 12 months. Mental component summary scores were negatively associated with mental illness 6 and 12 months postinjury. Integrated models of postdischarge comorbidity management need to be tested in burn patients.
烧伤前合并症会增加急性期死亡风险，并对幸存者的生活质量产生负面影响。迄今为止的研究仅将合并症评估为指标，限制了针对具体情况和制定降低风险策略的能力。因此，我们旨在评估特定疾病对烧伤后长期患者报告结果的差异影响。从 2007 年至 2018 年，前瞻性维护的创伤登记处与区域烧伤中心的患者报告结果的纵向数据库合并。系统地记录了人口统计学数据、损伤特异性信息和 20 种合并症的患病率。使用广义线性模型评估合并症对受伤后 6、12 和 24 个月时短表单 12/退伍军人 RAND 12（SF/VR-12）健康调查响应的影响。合并数据集包括 493 名成年参与者。中位年龄为 46 岁（四分位距，IQR 32-57 岁），72%为男性。中位烧伤面积为 14%TBSA（IQR 5-28%）。70%的参与者有≥1 种合并症（中位数为 1 种合并症/参与者；IQR 0-2 种合并症）。受伤后 6 个月和 12 个月时的 SF/VR-12 心理成分综合评分与精神疾病呈负相关（P<0.001，P=0.013）。SF/VR-12 身体成分综合（PCS）评分与吸烟（P=0.019）、糖尿病（P=0.001）和酒精使用障碍（P=0.001）在 6 个月随访时呈负相关。12 个月时的 SF/VR-12 PCS 评分与既往创伤入院（P=0.001）和糖尿病（P=0.042）呈负相关。24 个月时的 SF/VR-12 PCS 评分与精神疾病呈负相关（P=0.003）。吸烟、酒精使用障碍和糖尿病与受伤后 6 个月时的较低 PCS 评分相关；糖尿病在 12 个月时仍然是一个负相关的协变量。心理成分综合评分与受伤后 6 个月和 12 个月时的精神疾病呈负相关。需要在烧伤患者中测试出院后合并症管理的综合模型。
