Prediction of mortality in patients with major burns: clinical and biochemical factors.

Abstract

The plasma electric charge, in addition to clinical factors, was considered to improve the prediction of mortality in patients with major burns. A software called PICAL 5.0 was used to determinate the plasma electric charge in 143 patients with major burns from the intensive care burn unit-Unfallkrankenhaus Berlin (Germany). In addition, a retrospective study with these patients was developed involving: (1) biochemical variables in the first 48 hours: pH value, [albumin], [Ca(2+)], etc; (2) clinical aspects: age, total body surface area and full-thickness surface area burned, diagnosis of inhalation injury, etc. A mortality predictive equation was calculated from univariate and multivariate logistic regression analyses in a set of randomly chosen participants and applied to a validation set of 35 participants. The importance of each ion and protein for the equilibrium in the plasma charge is determinant. In statistical multivariate analysis, age, total body surface area burned, pH value, and [Mg(2+)] were independently associated with mortality. [Na(+)], [HCO(3)(-)] (bicarbonate), and [Cl(-)] are the ions contributing the most to the plasma charge equilibrium in patients with major burns; a loss of 50% of plasma proteins in the first 48 hours is equivalent to the loss of 1 mmol/L of HCO(3)(-). Moreover, the consideration of plasma biochemical parameters in the first 48 hours may improve the mortality predictive equation of mortality for burned victims.