6 Risk Factors and Comorbidities Associated with Post-burn Hypertension

Abstract Introduction Hypertension (HTN) is a prevalent condition in the United States and leads to an increased risk of developing other comorbidities. However, the impact of hypertension following severe burns on patient outcomes is not known. We hypothesize that post-burn hypertension is associated with an increased risk of other comorbidities and mortality. Methods This study used data from TriNetX, a global federated health research network. Burned patients who were diagnosed with essential hypertension at least 1 day after injury were identified in the TriNetX database using specific ICD codes and were compared to those who did not develop essential hypertension; neither cohort was diagnosed with hypertension prior to injury. Each cohort was balanced for age, gender, race, and ethnicity. Occurrence of the following within 3 days of burn was compared between the two cohorts: acute kidney injury (AKI), hyperglycemia, heart failure, coronary artery disease, and death. These patient cohorts were then stratified by gender, percent total body surface area (TBSA) burned, and age. Statistical analysis for the measures of association used an odds ratio with a 95% confidence interval and a risk ratio with a z-test. Significance for the z-test was set at a p-value of < 0.05. Results The search identified 460,977 burn patients of whom 87,808 were diagnosed with hypertension at least 1 day after burn injury. Those diagnosed with hypertension were 7.25 times as likely to develop AKI, 5.45 times as likely to develop hyperglycemia, 7 times as likely to develop heart failure, 7.17 times as likely to develop coronary artery disease, and 1.78 times as likely to die. Men were at greater risk of experiencing AKI, heart failure, coronary artery disease, and death, however, women were 1.51 times as likely to develop hyperglycemia. Stratification based on % TBSA burned indicated an increased risk for all outcomes for patients with a high percentage of total body surface area burned (60% to > 90% TBSA burned was higher than < 10% to 50-59% groups). Subgroup analysis based on age indicated elevated risk of developing AKI, heart failure, coronary artery disease, or death with age. However, we found a spike in risk for all outcomes in the 0-9 age group. All data was significant at p < .0001. Conclusions A new hypertension diagnosis in severely burned patients is highly associated with other comorbidities including acute kidney injury, heart failure, coronary artery disease, and death. Overall, males, older patients, and those with a higher percent TBSA burned are at a higher risk of developing these comorbidities.


Risk Factors and Comorbidities Associated with Post-burn Hypertension
Introduction: Hypertension (HTN) is a prevalent condition in the United States and leads to an increased risk of developing other comorbidities. However, the impact of hypertension following severe burns on patient outcomes is not known. We hypothesize that post-burn hypertension is associated with an increased risk of other comorbidities and mortality.
Methods: This study used data from TriNetX, a global federated health research network. Burned patients who were diagnosed with essential hypertension at least 1 day after injury were identified in the TriNetX database using specific ICD codes and were compared to those who did not develop essential hypertension; neither cohort was diagnosed with hypertension prior to injury. Each cohort was balanced for age, gender, race, and ethnicity. Occurrence of the following within 3 days of burn was compared between the two cohorts: acute kidney injury (AKI), hyperglycemia, heart failure, coronary artery disease, and death. These patient cohorts were then stratified by gender, percent total body surface area (TBSA) burned, and age. Statistical analysis for the measures of association used an odds ratio with a 95% confidence interval and a risk ratio with a z-test. Significance for the z-test was set at a p-value of < 0.05.

Results:
The search identified 460,977 burn patients of whom 87,808 were diagnosed with hypertension at least 1 day after burn injury. Those diagnosed with hypertension were 7.25 times as likely to develop AKI, 5.45 times as likely to develop hyperglycemia, 7 times as likely to develop heart failure, 7.17 times as likely to develop coronary artery disease, and 1.78 times as likely to die. Men were at greater risk of experiencing AKI, heart failure, coronary artery disease, and death, however, women were 1.51 times as likely to develop hyperglycemia. Stratification based on % TBSA burned indicated an increased risk for all outcomes for patients with a high percentage of total body surface area burned (60% to > 90% TBSA burned was higher than < 10% to 50-59% groups). Subgroup analysis based on age indicated elevated risk of developing AKI, heart failure, coronary artery disease, or death with age. However, we found a spike in risk for all outcomes in the 0-9 age group. All data was significant at p < .0001.

Conclusions:
A new hypertension diagnosis in severely burned patients is highly associated with other comorbidities including acute kidney injury, heart failure, coronary artery disease, and death. Overall, males, older patients, and those with a higher percent TBSA burned are at a higher risk of developing these comorbidities.
Introduction: Acute alcohol intoxication in burn patients has been associated with increased mortality, renal dysfunction and difficulty with adequate fluid resuscitation. It is less clear how chronic alcohol use, regardless of intoxication status on admission, impacts patient outcomes. In this study, we examine chronic alcohol use and both short-and longterm outcomes in burn patients. Methods: Patients were identified using an institutional burn center registry and linked to clinical data. Adults admitted from 2017 to 2020 with a total body surface area (TBSA) % above 10% and a hospital stay greater than 2 days were eligible for inclusion. A total of 298 patients were enrolled and chart review completed for admission labs and fluid administration. Alcohol use was also examined and patients were staged based on severity and chronicity of alcohol use: none/minimal, early/moderate use, and problem/severe abuse. Renal dysfunction was defined based on Acute Kidney Injury Network criteria. Linear regression was used to assess the association between alcohol use and fluid resuscitation. Multiple logistic regression was used to assess alcohol use and renal dysfunction with adjustment for confounders. Although there was a trend toward increased rates of acute renal injury within 48 hours of admission in the PS group (32.7%) vs the NM group (21%), this did not reach statistical significance. Conclusions: Chronic alcohol use was associated with more severe burn injury, increased morbidity and mortality, and greater resource use. Even after adjustment for comorbidities and TBSA, chronic alcohol use resulted in a need for increased initial fluid resuscitation.