Significance of early acidosis in predicting early mortality among flame burned patients in a Kenyan National Hospital

Abstract

Aim: Burn pathophysiology, fluid therapy and mortality prediction have been assessed by various parameters including lactate and base deficit serum  markers. The objective of this study was to assess the significance of early acidosis recorded within 24 hours of flame burn injury in predicting early (5  day) mortality among flame burned patients.

Study design and Methodology: This was a cohort observational study. Eighty flame injured patients presenting within 24 hours of incident were  consecutively recruited into the study and immediately assessed for arterial blood pH, lactate and base deficit (BD). While undergoing their treatment  according to the admitting hospital’s protocal, their mortality as the sole outcome of interest was recorded until day 28. Receiver operating characteristics  curves were drawn;area under curve, cut offs, sensitivities and specificities for BD, lactate and pH were determined for mortality within  the first 5 days of admission. The cut offs were used to derive contingency tables for calculation of predictive values. Odds ratios were calculated at 95%  confidence interval. Twenty-eight-day survival curve was generated. Level of significance was <0.05.

Results: 28-day mortality was 39%. Five-day mortality  was 24%. The latter was predicted by alactate level of 2.36 mmol/L, BD of -10.05 mmol/L and pH of 7.344 with 75%,74% and 95% sensitivities  respectively. Odds of patients dying at these levels or worse were 6.3, 11.4 and 36.9 respectively all with significant p-values.

Conclusion: Arterial pH,  base deficit and lactate are good predictors of 5-day mortality among fire victims.