Study Identifies Factors that Predict ARDS in Burn Patients
Wednesday, August 29, 2018

Study Identifies Three Factors that Predict Respiratory Disease in Burn Patients

Doctor looking at x-ray on tablet

MAYWOOD, IL – For the first time, researchers have devised a model to predict burn patients who are most likely to develop life-threatening acute respiratory distress syndrome (ARDS).

In the journal Annals of Surgery, researchers reported the prediction model includes three factors: the extent of the patient's inhalation injury, the percentage of the patient's body that was burned and whether the patient had high levels of a blood clotting protein called von Willebrand factor.

The first author is Majid Afshar, MD, MSCR, an assistant professor in the Department of Public Health Sciences and in the division of pulmonary and critical care medicine in the department of medicine of Loyola Medicine and Loyola University Chicago Stritch School of Medicine.

The three-pronged model "could be used to better identify at-risk patients for both the study and prevention of ARDS in patients with burn injury," Dr. Afshar and colleagues wrote.

ARDS is a form of respiratory failure caused by inflammation and the inability to exchange oxygen appropriately. Patients typically are put on ventilators, and many don't survive.

ARDS usually occurs in patients who already are critically ill from predisposing conditions such as sepsis, pneumonia, burns, inhalation injury, traumatic injuries, etc. Burn injuries, especially those involving inhalation injuries, have the highest incidence of ARDS among all predisposing conditions.

Previously, patients with large burns had high mortality rates so few survived to develop ARDS. Treatments have greatly improved in the past 20 years and now more patients are surviving major burns. More than 25 percent of patients with large burns or major inhalation injuries who survive the first 24 hours will develop ARDS.

The prospective multicenter study included 113 adult patients who were treated at Loyola Medicine's Burn Center and the University of Colorado's Burn Center. The patients had burns over at least 10 percent of their bodies and/or were suspected of having inhalation injury. About one-third (33.6 percent) developed ARDS a median of 2.2 days after their injuries.

In developing their prediction model, researchers examined clinical characteristics including burn and inhalation injury, alcohol misuse and current tobacco use; other health problems including diabetes, congestive heart failure, heart disease and chronic obstructive pulmonary disease (COPD); and five protein biomarkers found in plasma (the colorless fluid part of blood).

Among multiple prediction models examined, a model consisting of inhalation injury, the von Willebrand factor biomarker and the percent of body burned did the best job of predicting which patients were most likely to develop ARDS.

Dr. Afshar and colleagues wrote that once the model is validated by other studies, it could guide clinical trials designed to prevent ARDS and identify burn patients who are at risk for ARDS.

The study was supported by grants from the National Institute of General Medical Sciences and National Institute of Alcoholism and Alcohol Abuse. It is titled, "Injury Characteristics and von Willebrand Factor for the Prediction of Acute Respiratory Distress Syndrome in Patients with Burn Injury."

In addition to Dr. Afshar, other co-authors are Ellen L. Burnham, MD, MS, Cara Joyce, PhD, Robin Gagnon, Robert Dunn, Joslyn M. Albright, MD, Louis Ramirez, John E. Repine, MD, Giora Netzer, MD, MSCE, and Elizabeth J. Kovacs, PhD.

Loyola's Burn Center is the largest burn center in Illinois. The center delivers clinically integrated care for the most complex cases. Loyola's outstanding success rates and multidisciplinary approach are recognized by the American College of Surgeons and American Burn Association.

About Loyola Medicine and Trinity Health

Loyola Medicine, a member of Trinity Health, is a quaternary care system based in the western suburbs of Chicago that includes Loyola University Medical Center (LUMC), Gottlieb Memorial Hospital, MacNeal Hospital and convenient locations offering primary and specialty care services from 1,877 physicians throughout Cook, Will and DuPage counties. LUMC is a 547-licensed-bed hospital in Maywood that includes the William G. and Mary A. Ryan Center for Heart & Vascular Medicine, the Cardinal Bernardin Cancer Center, a Level 1 trauma center, Illinois's largest burn center, a certified comprehensive stroke center and a children’s hospital. Having delivered compassionate care for over 50 years, Loyola also trains the next generation of caregivers through its teaching affiliation with Loyola University Chicago’s Stritch School of Medicine and Marcella Niehoff School of Nursing. Gottlieb is a 247-licensed-bed community hospital in Melrose Park with 150 physician offices, an adult day care program, the Gottlieb Center for Fitness, the Loyola Center for Metabolic Surgery and Bariatric Care and the Loyola Cancer Care & Research at the Marjorie G. Weinberg Cancer Center at Melrose Park. MacNeal Hospital is a 374-bed teaching hospital in Berwyn with advanced inpatient and outpatient medical, surgical and psychiatric services, advanced diagnostics and treatments. MacNeal has a 12-bed acute rehabilitation unit, a 25-bed inpatient skilled nursing facility, and a 68-bed behavioral health program and community clinics. MacNeal has provided quality, patient-centered care to the near west suburbs since 1919.

Trinity Health is one of the largest multi-institutional Catholic healthcare systems in the nation, serving diverse communities that include more than 30 million people across 22 states. Trinity Health includes 94 hospitals, as well as 109 continuing care locations that include PACE programs, senior living facilities and home care and hospice services. Its continuing care programs provide nearly 2.5 million visits annually. Based in Livonia, Mich., and with annual operating revenues of $18.3 billion and assets of $26.2 billion, the organization returns $1.1 billion to its communities annually in the form of charity care and other community benefit programs. Trinity employs about 133,000 colleagues, including 7,800 employed physicians and clinicians. Committed to those who are poor and underserved in its communities, Trinity is known for its focus on the country's aging population. As a single, unified ministry, the organization is the innovator of Senior Emergency Departments, the largest not-for-profit provider of home health care services—ranked by number of visits—in the nation, as well as the nation’s leading provider of PACE (Program of All Inclusive Care for the Elderly) based on the number of available programs.