Addition of admission lactate levels to Baux score improves mortality prediction in severe burns

Abstract Risk adjustment and mortality prediction models are central in optimising care and for benchmarking purposes. In the burn setting, the Baux score and its derivatives have been the mainstay for predictions of mortality from burns. Other well-known measures to predict mortality stem from the...

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Autores principales:	Ingrid Steinvall, Moustafa Elmasry, Islam Abdelrahman, Ahmed El-Serafi, Folke Sjöberg
Formato:	article
Lenguaje:	EN
Publicado:	Nature Portfolio 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/6899455ebe064083a461202deaa1c97c
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spelling	oai:doaj.org-article:6899455ebe064083a461202deaa1c97c2021-12-02T14:58:47ZAddition of admission lactate levels to Baux score improves mortality prediction in severe burns10.1038/s41598-021-97524-92045-2322https://doaj.org/article/6899455ebe064083a461202deaa1c97c2021-09-01T00:00:00Zhttps://doi.org/10.1038/s41598-021-97524-9https://doaj.org/toc/2045-2322Abstract Risk adjustment and mortality prediction models are central in optimising care and for benchmarking purposes. In the burn setting, the Baux score and its derivatives have been the mainstay for predictions of mortality from burns. Other well-known measures to predict mortality stem from the ICU setting, where, for example, the Simplified Acute Physiology Score (SAPS 3) models have been found to be instrumental. Other attempts to further improve the prediction of outcome have been based on the following variables at admission: Sequential Organ Failure Assessment (aSOFA) score, determinations of aLactate or Neutrophil to Lymphocyte Ratio (aNLR). The aim of the present study was to examine if estimated mortality rate (EMR, SAPS 3), aSOFA, aLactate, and aNLR can, either alone or in conjunction with the others, improve the mortality prediction beyond that of the effects of age and percentage total body surface area (TBSA%) burned among patients with severe burns who need critical care. This is a retrospective, explorative, single centre, registry study based on prospectively gathered data. The study included 222 patients with median (25th–75th centiles) age of 55.0 (38.0 to 69.0) years, TBSA% burned was 24.5 (13.0 to 37.2) and crude mortality was 17%. As anticipated highest predicting power was obtained with age and TBSA% with an AUC at 0.906 (95% CI 0.857 to 0.955) as compared with EMR, aSOFA, aLactate and aNLR. The largest effect was seen thereafter by adding aLactate to the model, increasing AUC to 0.938 (0.898 to 0.979) (p < 0.001). Whereafter, adding EMR, aSOFA, and aNLR, separately or in combinations, only marginally improved the prediction power. This study shows that the prediction model with age and TBSA% may be improved by adding aLactate, despite the fact that aLactate levels were only moderately increased. Thereafter, adding EMR, aSOFA or aNLR only marginally affected the mortality prediction.Ingrid SteinvallMoustafa ElmasryIslam AbdelrahmanAhmed El-SerafiFolke SjöbergNature PortfolioarticleMedicineRScienceQENScientific Reports, Vol 11, Iss 1, Pp 1-9 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Ingrid Steinvall Moustafa Elmasry Islam Abdelrahman Ahmed El-Serafi Folke Sjöberg Addition of admission lactate levels to Baux score improves mortality prediction in severe burns
description	Abstract Risk adjustment and mortality prediction models are central in optimising care and for benchmarking purposes. In the burn setting, the Baux score and its derivatives have been the mainstay for predictions of mortality from burns. Other well-known measures to predict mortality stem from the ICU setting, where, for example, the Simplified Acute Physiology Score (SAPS 3) models have been found to be instrumental. Other attempts to further improve the prediction of outcome have been based on the following variables at admission: Sequential Organ Failure Assessment (aSOFA) score, determinations of aLactate or Neutrophil to Lymphocyte Ratio (aNLR). The aim of the present study was to examine if estimated mortality rate (EMR, SAPS 3), aSOFA, aLactate, and aNLR can, either alone or in conjunction with the others, improve the mortality prediction beyond that of the effects of age and percentage total body surface area (TBSA%) burned among patients with severe burns who need critical care. This is a retrospective, explorative, single centre, registry study based on prospectively gathered data. The study included 222 patients with median (25th–75th centiles) age of 55.0 (38.0 to 69.0) years, TBSA% burned was 24.5 (13.0 to 37.2) and crude mortality was 17%. As anticipated highest predicting power was obtained with age and TBSA% with an AUC at 0.906 (95% CI 0.857 to 0.955) as compared with EMR, aSOFA, aLactate and aNLR. The largest effect was seen thereafter by adding aLactate to the model, increasing AUC to 0.938 (0.898 to 0.979) (p < 0.001). Whereafter, adding EMR, aSOFA, and aNLR, separately or in combinations, only marginally improved the prediction power. This study shows that the prediction model with age and TBSA% may be improved by adding aLactate, despite the fact that aLactate levels were only moderately increased. Thereafter, adding EMR, aSOFA or aNLR only marginally affected the mortality prediction.
format	article
author	Ingrid Steinvall Moustafa Elmasry Islam Abdelrahman Ahmed El-Serafi Folke Sjöberg
author_facet	Ingrid Steinvall Moustafa Elmasry Islam Abdelrahman Ahmed El-Serafi Folke Sjöberg
author_sort	Ingrid Steinvall
title	Addition of admission lactate levels to Baux score improves mortality prediction in severe burns
title_short	Addition of admission lactate levels to Baux score improves mortality prediction in severe burns
title_full	Addition of admission lactate levels to Baux score improves mortality prediction in severe burns
title_fullStr	Addition of admission lactate levels to Baux score improves mortality prediction in severe burns
title_full_unstemmed	Addition of admission lactate levels to Baux score improves mortality prediction in severe burns
title_sort	addition of admission lactate levels to baux score improves mortality prediction in severe burns
publisher	Nature Portfolio
publishDate	2021
url	https://doaj.org/article/6899455ebe064083a461202deaa1c97c
work_keys_str_mv	AT ingridsteinvall additionofadmissionlactatelevelstobauxscoreimprovesmortalitypredictioninsevereburns AT moustafaelmasry additionofadmissionlactatelevelstobauxscoreimprovesmortalitypredictioninsevereburns AT islamabdelrahman additionofadmissionlactatelevelstobauxscoreimprovesmortalitypredictioninsevereburns AT ahmedelserafi additionofadmissionlactatelevelstobauxscoreimprovesmortalitypredictioninsevereburns AT folkesjoberg additionofadmissionlactatelevelstobauxscoreimprovesmortalitypredictioninsevereburns
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Addition of admission lactate levels to Baux score improves mortality prediction in severe burns

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