Occurrence of multiorgan dysfunction in pediatric burn patients: incidence and clinical outcome

Abstract

Objective: To examine the incidence of single or multiple organ failure postburn and its resultant clinical outcomes during acute hospitalization.

Background: Patient outcomes are inherently dependent on intact organ function; however, burn injury affects the structure and function of almost every organ, but especially lung, liver, kidney, and heart. Therefore, single-organ failure and/or multiorgan failure (MOF) are thought to contribute significantly to postburn morbidity and mortality, but to date no large trial examining the effects of MOF on postburn outcomes exists.

Methods: Incidence of MOF was monitored in 821 pediatric burn patients during acute hospitalization. Patients were divided into groups on the basis of the incidence of single-organ-specific failure, MOF, and non-MOF. The DENVER2 score was used to assess organ-specific scores for lung, liver, kidney, and heart. The patient's demographics, injury characteristics, and outcome parameters were recorded.

Results: Respiratory failure has the highest incidence in the early phase of postburn injury and decreases starting 5 days postburn. Cardiac failure was noted to have the highest incidence throughout hospital stay. Incidence of hepatic failure increases with the hospital length of stay and is associated with a high mortality during the late phase of the acute hospital stay. Renal failure has an unexpectedly low incidence but is associated with a high mortality during the first 3 weeks postburn injury. Three or more organ failure is associated with very high mortality.

Conclusions: This is the first large study in burn patients to determine the incidence of organ-specific failure and outcome. The results of this study confirmed the expected chronologic incidence of organ-specific failure and yield the long-term mortality from liver and renal failure.

Trial registration: ClinicalTrials.gov NCT00673309.

Conflict of interest statement

Conflicts of Interest

Authors declare no conflicts of interest.

Figures

Figure 1. Survival curve for the first 60 days after injury

The mortality rate in patients without MOF was significantly higher during the acute hospitalization. Mortality after day 30 plateaued in the non-MOF group, whereas patients with MOF showed a constant mortality rate till day 60.

Figure 2

Daily average glucose levels, an indicator for stress induced insulin resistance and metabolic dysfunction is associated with the incidence of MOF. Significantly higher systemic glucose levels can be seen in patients with incidence of MOF.

Figure 3

Biochemical markers for inflammation such as IL-6, MCP-1, TNF-α, and CRP compared between the MOF and non-MOF group.

Figure 4

Survival curve of patients stratified according specific organ failure.

Figure 5

Average of DENVER2 points over time for the first 60 days after burn injury of all patients. Respiratory failure tends to decrease after within the first 10 days after injury whereas liver failure has an increasing trend over the first 60 days. Renal and cardiac dysfunction remain at relatively stable along the hospital course.