Poster Presentation ESA-SRB-APEG-NZSE 2022

Prevalence of and factors associated with dysglycaemia in adult burn inpatients (#283)

Jeffrey Chandra 1 , Edward Raby 2 , Fiona Wood 2 , Bu B Yeap 1 3 , P Gerry Fegan 3 4
  1. Medical School, University of Western Australia, Perth, Australia
  2. State Adult Burns Unit, Fiona Stanley Hospital, Perth, WA, Australia
  3. Department of Endocrinology and Diabetes, Fiona Stanley Hospital, Perth, Australia
  4. Medical School, Curtin University, Perth, Australia

Aim/Background:

Severe burns can precipitate hyperglycaemia. (1) Hospitalised patients with burns and diabetes have greater morbidity than those without diabetes, however there is limited information on glycaemia during acute burns admissions. (2, 3) This study examines the extent of dysglycaemia in burns inpatients with known diabetes, and of stress hyperglycaemia in patients without diabetes.

Methods:

Retrospective cohort study at a tertiary centre of acute hospitalisations from burn injuries. Patients were categorised based on medical history as having known diabetes (n=30) or no known diabetes (n=260). Burn injuries assessed as percentage total body surface area affected (%TBSA). Glycaemic measures included blood sugar level (BSL), hyperglycaemic episodes (BSL 11.1mmol/L) and dysglycemic days (BSL 4 or 16). Length of stay (LOS) was another outcome.

Results:

Admitted patients with known diabetes experienced significantly higher BSLs (9.7 vs 9.0 mmol/L, p<0.001) with a greater proportion experiencing hyperglycaemia (28.0 vs 17.2%, p<0.001) and dysglycaemic days (22.4 vs 8.06%, p<0.001), compared to those without known diabetes despite significantly lower TBSA (1.0 vs 14.8%, p<0.001). Patients with stress hyperglycaemia (N=14) had BSLs comparable to those with known diabetes (admission 10.3 vs 11.5 mmol/L; during admission 9.9 vs 9.9 mmol/L), but more severe burns (15.6% vs 1.0% TBSA) and longer LOS (18 vs 7 days, p<0.001). Presence of known diabetes and extent of burns were predictors of longer LOS In the cohort as a whole (both p<0.001).

Conclusions:

In patients with known diabetes, relatively small burn injuries may result in hyperglycaemia, whereas in burns patients generally both the presence of diabetes and extent of burns are predictors of longer LOS. Stress hyperglycaemia occurs in patients with substantive burn injuries, resulting in promptly elevated BSLs and longer LOS. There is scope to improve inpatient management of BSLs and to investigate whether this would improve longer term clinical outcomes following burns.

  1. Williams FN, Herndon DN, Jeschke MG. The hypermetabolic response to burn injury and interventions to modify this response. Clin Plast Surg. 2009;36(4):583-596. doi:10.1016/j.cps.2009.05.001
  2. Dolp, R., Rehou, S., Pinto, R. et al. The effect of diabetes on burn patients: a retrospective cohort study. Crit Care 23, 28 (2019). https://doi.org/10.1186/s13054-019-2328-6
  3. Momeni M, Jafarian AA, Maroufi SS, Ranjpour F, Karimi H. Diabetes and foot burns. Ann Burns Fire Disasters. 2018;31(3):181-184.