State Key Laboratory of Trauma, Burn and Combined Injury, Institute of Burn Research, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China.
J Burn Care Res. 2021 May 7;42(3):448-453. doi: 10.1093/jbcr/iraa173.
The Meek technique is currently a key method for treating wounds in severely burned patients. The survival rate of skin grafts is an important factor affecting the success rate of treatment. The purpose of this study was to investigate the effect of the preoperative prognostic nutritional index (PNI) on the survival rate of skin grafts in patients treated with the Meek technique in the early stage of severe burns. We retrospectively analyzed the data of severely burned patients who were treated at the burn center between January 2013 and December 2019 and met the inclusion criteria. The albumin (ALB) level and lymphocyte count obtained 1 day before the operation was used to calculate the preoperative PNI (PNI = serum ALB level [g/L] + 5 × total number of peripheral blood lymphocytes [×109/L]). According to the survival rates of skin grafts 14 days after the operation, patients with severe burns were divided into a group with good skin graft survival (survival rate ≥75%, abbreviated as group G) and a group with poor skin graft survival (survival rate <75%, abbreviated as group P). Receiver-operating characteristic (ROC) curves and univariate and multivariate analyses were used to evaluate the predictive value of the preoperative PNI for the prognosis of patients treated with the Meek technique. One hundred and twenty-one patients were enrolled in this study. Groups G (n = 66 cases) and P (n = 55 cases) did not have significant differences in age, sex, and body mass index (P > .05). The total burned surface area, burn index, platelet-to-lymphocyte ratio, preoperative platelet count, operative time, total protein, albumin level, globulin level, and PNI were the risk factors affecting the survival of Meek grafts. The burn index was an independent risk factor for poor skin graft survival (odds ratio [OR]: 1.049, 95% confidence interval [CI]: 1.020-1.079; P < .05). The preoperative PNI was a protective factor against poor skin graft survival (OR: 0.646, 95% CI: 0.547-0.761; P < .05). The ROC curve determined that the optimal cut-off value for the preoperative PNI was 34.98. There were 59 cases with PNI > 34.98 (the high PNI group) and 62 cases with PNI < 34.98 (the low PNI group). The survival rate of skin grafts in patients with a high PNI was generally significantly higher than that of patients with a low preoperative PNI (P < .05). Five (8.47%) patients in the high PNI group died, compared with 16 (25.8%) patients in the low PNI group. The difference in the mortality rate between the two groups was significant (P < .05). Preoperative PNI can be used as a predictor of the survival rate of skin grafts in patients treated with the Meek technique in the early stage of severe burns.
微创技术目前是治疗严重烧伤患者伤口的关键方法。皮肤移植物的存活率是影响治疗成功率的一个重要因素。本研究旨在探讨术前预后营养指数（PNI）对早期严重烧伤患者采用微创技术治疗时皮肤移植物存活率的影响。我们回顾性分析了 2013 年 1 月至 2019 年 12 月在烧伤中心接受治疗且符合纳入标准的严重烧伤患者的数据。根据术前 1 天获得的白蛋白（ALB）水平和淋巴细胞计数，计算术前 PNI（PNI=血清 ALB 水平[g/L]+5×外周血淋巴细胞总数[×109/L]）。根据术后 14 天皮肤移植物的存活率，将严重烧伤患者分为皮肤移植物存活率良好的组（存活率≥75%，简称 G 组）和皮肤移植物存活率差的组（存活率<75%，简称 P 组）。采用受试者工作特征（ROC）曲线和单因素及多因素分析评估术前 PNI 对微创技术治疗患者预后的预测价值。本研究共纳入 121 例患者。G 组（n=66 例）和 P 组（n=55 例）在年龄、性别和体重指数方面无显著差异（P>0.05）。总烧伤面积、烧伤指数、血小板与淋巴细胞比值、术前血小板计数、手术时间、总蛋白、白蛋白水平、球蛋白水平和 PNI 是影响微创移植皮片存活率的危险因素。烧伤指数是皮肤移植物存活率差的独立危险因素（比值比[OR]：1.049，95%置信区间[CI]：1.020-1.079；P<0.05）。术前 PNI 是皮肤移植物存活率差的保护因素（OR：0.646，95%CI：0.547-0.761；P<0.05）。ROC 曲线确定术前 PNI 的最佳截断值为 34.98。术前 PNI>34.98 有 59 例（高 PNI 组），术前 PNI<34.98 有 62 例（低 PNI 组）。高 PNI 组患者的皮肤移植物存活率普遍明显高于低 PNI 组（P<0.05）。高 PNI 组 5 例（8.47%）患者死亡，低 PNI 组 16 例（25.8%）患者死亡。两组死亡率差异有统计学意义（P<0.05）。术前 PNI 可作为预测严重烧伤患者采用微创技术早期皮肤移植物存活率的指标。
