Clinical Outcomes Associated with Prior GLP-1 Exposure in Burned Patients.

Abstract

Glucagon-like peptide-1 (GLP-1) receptor agonists have anti-inflammatory and immunomodulatory properties beyond glycemic control. Their impact on burn injury outcomes remains unexplored. This study assessed the potential impact of prior GLP-1 exposure on mortality, infectious complications, and critical care utilisation in burn patients. Using the TriNetX US Network, adult patients with thermal burns ≤20% total body surface area (TBSA) between January 2018 and November 2025 were identified. Patients with GLP-1 documentation within one year before burn injury were propensity score matched with controls for age, sex, race, comorbidities, TBSA, body mass index (BMI), and hemoglobin A1c (HbA1c). Outcomes included 1-year mortality, infectious complications, critical care utilisation, and wound management outcomes. Sensitivity analyses examined 6-month and 3-year exposure windows. After matching, 8,307 patients per cohort were included. GLP-1 exposure was associated with 54% reduced odds of mortality (odds ratio [OR] 0.46, p<0.001), 35% reduced intensive care unit admission (OR 0.65, p<0.001), and 62% reduced intubation (OR 0.38, p<0.001). Infectious complications were significantly decreased, including sepsis (32% reduction), pneumonia (24% reduction), and methicillin-resistant Staphylococcus aureus (MRSA) infections (27% reduction). The odds of broad-spectrum antibiotic use decreased 21%. Benefits persisted across all exposure windows. The 3-year cohort demonstrated a 27% increase in hypertrophic scarring (OR 1.27, p=0.031). Prior GLP-1 receptor agonist use was associated with a significant decrease in mortality, infectious complications, and critical care utilisation among burn patients, independent of metabolic factors like BMI. These findings warrant prospective studies to optimize perioperative management strategies in this patient population.