Nutritional assessment indications of postburn complications.

This study evaluates the use of nutritional assessment indexes measured on the fifth day after injury to predict subsequent wound infections, episodes of septicemia, and other infectious complications in burned patients. Nutritional assessment data collected included anthropometric measurements (weight, height, triceps skinfold, and upper-arm circumference); biochemical testing (serum albumin concentration, serum transferrin concentration, total lymphocyte count, creatinine/height index, and nitrogen balance); and recall skin antigen testing. Seventy-four adult patients (mean age of 35 years) who had burn injuries ranging from 10% to 96% total body surface were studied. Indexes predictive of imminent wound infection include serum transferrin concentrations less than 150 mg/dl (p = .0006) and anergy to the skin test battery (p = .01). Those indexes were also prognostic of the development of septicemia (p = .0002 and p = .0001, respectively). Although statistically insignificant, total lymphocyte count also showed a similar trend toward predicting complications. Serum albumin concentration (less than 3.0 gm/dl), creatinine/height index (less than 60% standard), percent ideal body weight (less than 80%), percent weight change, and nitrogen balance did not contribute to group discrimination. Severe depletion of the visceral protein compartment was documented in a large percentage of patients on the fifth postburn day. Serum transferrin concentration and recall skin antigen testing can be helpful in identifying thermally injured patients who are at high risk of infectious complications.