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肌肉消耗对烧伤患者预后的影响:一项烧伤护理质量平台研究。

The Influence of Muscle Wasting on Patient Outcomes among Burn Patients: A Burn Care Quality Platform Study.

作者信息

Blears Elizabeth, Murton Andrew, Caffery Julie

机构信息

Department of Plastic Surgery, Johns Hopkins Bayview Medical Center, Baltimore, MD 21224, USA.

Department of Plastic Surgery, Tower Health Hospital System, West Reading, PA 19611, USA.

出版信息

J Burn Care Res. 2025 Jan 24;46(1):75-81. doi: 10.1093/jbcr/irae190.

Abstract

The hypermetabolism that occurs after large burns leads to muscle wasting that can result in weakness, difficulty fighting infections, and other challenges to healing. Overall, rates of muscle wasting are not well established across burn centers. The Burn Care Quality Platform (BCQP), the largest available dataset on burn patients globally, was used to explore the rate of Muscle Wasting using data collected from more than 100 burn centers. "Muscle Wasting" was defined from relevant ICD codes (sarcopenia, muscle cachexia, protein malnutrition). Binomial and logistic regression were used to analyze the role of Muscle Wasting in burn mortality and other outcomes after controlling for demographic and comorbid characteristics. In total, the BCQP provided data from 84 438 adult and pediatric burn patients injured between 2000 and 2018. Only 2.6% (N = 2159) of the patients in the BCQP were diagnosed with having Muscle Wasting at some point during their admission. While Muscle Wasting was not associated with a statistically significant impact on mortality, it remained an independent predictor of inability to discharge to independent living, longer inpatient days, as well as an average of 10 additional surgical procedures (P < .001 for all) as compared to patients who did not have Muscle Wasting. Muscle Wasting is an independent risk factor for several adverse outcomes in burn patients, but not mortality in the BCQP. Confidence in these findings would be improved with more accurate data collection, as the diagnosis of Muscle Wasting is likely under-reported, under-diagnosed, or both.

摘要

大面积烧伤后出现的高代谢会导致肌肉萎缩,进而可能引发虚弱、抗感染能力下降以及愈合过程中的其他问题。总体而言,各烧伤中心的肌肉萎缩发生率尚无确切定论。全球最大的烧伤患者数据集——烧伤护理质量平台(BCQP),被用于利用从100多个烧伤中心收集的数据来探究肌肉萎缩的发生率。“肌肉萎缩”是根据相关国际疾病分类代码(肌肉减少症、肌肉恶病质、蛋白质营养不良)来定义的。在控制了人口统计学和合并症特征后,使用二项式回归和逻辑回归分析肌肉萎缩在烧伤死亡率及其他结局中的作用。BCQP总共提供了2000年至2018年间84438例成人和儿童烧伤患者的数据。在BCQP中,只有2.6%(N = 2159)的患者在住院期间的某个时间点被诊断患有肌肉萎缩。虽然肌肉萎缩对死亡率没有统计学上的显著影响,但与未发生肌肉萎缩的患者相比,它仍然是无法出院独立生活、住院时间延长以及平均多进行10次外科手术的独立预测因素(所有P值均<0.001)。在BCQP中,肌肉萎缩是烧伤患者出现多种不良结局的独立危险因素,但不是死亡率的独立危险因素。随着数据收集更加准确,对这些研究结果的信心将会增强,因为肌肉萎缩的诊断很可能存在报告不足、诊断不足或两者皆有的情况。

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