Trajectories of longitudinal biomarkers for mortality in severely burned patients

Abstract

This study aimed to investigate the differences in the trajectory of blood biomarkers routinely assessed through forward- and backward-looking approaches among burn patients. This cohort study included patients above 18 years of age from February 2007 to December 2018. All the biomarkers were estimated from admission to discharge from the intensive care unit. Significant differences were observed in the platelet count at 40 days, prothrombin time (PT) at 32 days, white blood cell count at 26 days, creatinine levels at 22 days, and lactate and total bilirubin levels at 19 days before death. In reverse order, significant differences were observed in the fitted model in platelet count at 44 days and in the platelet count and PT at 33 days. We obtained more valuable information from the longitudinal biomarker trajectory using the backward-looking method than using the forward-looking method. The platelet count served as the earliest predictor of mortality among burn patients.

Figure 1

Trajectory of mean value for each biomarker between survivors and non-survivors. Error bar is 95% confidence interval calculated by bootstrap.

Figure 2

Plots over the time of predicted value using linear mixed effect model adjusted with risk factors, such as age, TBSA, and inhalation injury in forward and backward manner. Error bar is 95% confidence interval of predicted value.