Can systemic inflammatory response syndrome score at admission predict clinical outcome in patients with severe burns?

Abstract

Introduction: The use of SIRS score as a predictor of outcomes in patients with severe burns has not been fully evaluated. Here, we aimed to test that whether admission SIRS score, combining with other predictors, could be used in predicting outcomes in patients with severe burns. Additionally, we compared the prognostic accuracy of admission SIRS score with other score systems and newly developed models.

Methods: We performed a retrospective study of adult patients with ≥40% total body surface area burns admitted to a burn center from 2005 to 2017. The primary outcome was in-hospital mortality, and the secondary outcomes were hospital and intensive care unit length of stay. SIRS score, rBaux score, ABSI and newly developed models were compared using area under the receiver operating characteristic curve analysis.

Results: Out of the total 144 patients, 128 (88.9%) met SIRS criteria on admission; with a predominant SIRS scores of 3. Patients with admission SIRS were more likely to have larger burns and have higher rBaux and ABSI scores when compared with non-SIRS patients. With the each increment of admission SIRS score, total and full-thickness burn areas, proportion of inhalation injury, tracheostomy and mortality increased significantly. However, SIRS score at admission was not increasingly predictive of deleterious outcomes when analyzed by multivariable regression analysis. Although the combination of SIRS score, age, and burn-specific variables showed better or equal prognostication of outcomes than that of other score systems, the contribution of the variable SIRS score was negligible.

Conclusions: The model with the variables age, percentage full-thickness burns, and inhalation injury provided excellent prediction of poor outcomes in patients with severe burns, while SIRS score has limited use for prognostic determinations.

Keywords: Burn; Mortality; SIRS; Scores.