Differential benefits of steroid therapies in adults following major burn injury

Khaled Altarrah*, Poh Tan, Animesh Acharjee, Jon Hazeldine, Barbara Torlinska, Yvonne Wilson, Tomasz Torlinski, Naiem Moiemen, Janet Lord

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

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Abstract

Background: Major thermal injury induces a complex pathophysiological state characterized by burn shock and hypercatabolism. Steroids are used to modulate these post-injury responses. However, the effects of steroids on acute post-burn outcomes remain unclear. Methods: In this study of 52 thermally injured adult patients (median total burn surface area 42%, 33 males and 19 females), the effects of corticosteroid and oxandrolone on mortality, multi-organ failure (MOF), and sepsis were assessed individually. Clinical data were collected at days 1, 3, 7, and 14 post-injury. Results: Twenty-two (42%) and 34 (65%) burns patients received corticosteroids and oxandrolone within the same cohort, respectively. Following separate analysis for each steroid, corticosteroid use was associated with increased odds of in-hospital mortality (OR 3.25, 95% CI: 1.32–8•00), MOF (OR 2.36, 95% CI: 1.00–1.55), and sepsis (OR 5.95, 95% CI: 2.53–14.00). Days alive (HR 0.32, 95% CI: 0.18–0.60) and sepsis-free days (HR 0.54, 95% CI: 0.37–0.80) were lower among corticosteroid-treated patients. Oxandrolone use was associated with reduced odds of 28-day mortality (OR 0.11, 95% CI: 0.04–0.30), in-hospital mortality (OR 0.19, 95% CI: 0.08–0.43), and sepsis (OR 0.24, 95% CI: 0.08–0.69). Days alive, at 28 days (HR 6.42, 95% CI: 2.77–14.9) and in-hospital (HR 3.30, 95% CI: 1.93–5.63), were higher among the oxandrolone-treated group. However, oxandrolone was associated with increased MOF odds (OR 7.90, 95% CI: 2.89–21.60) and reduced MOF-free days (HR 0.23, 95% CI: 0.11–0.50). Conclusion: Steroid therapies following major thermal injury may significantly affect patient prognosis. Oxandrolone was associated with better outcomes except for MOF. Adverse effects of corticosteroids and oxandrolone should be considered when managing burn patients.

Original languageEnglish
Pages (from-to)2616-2624
Number of pages9
JournalJournal of Plastic, Reconstructive & Aesthetic Surgery
Volume75
Issue number8
Early online date20 Apr 2022
DOIs
Publication statusPublished - 17 Aug 2022

Bibliographical note

Funding Information:
Funding for the delivery of the study is supported by the Chancellor using LIBOR funds via a grant obtained by The Scar Free Foundation, UK. KA was funded by Ministry of Health and Civil Service Commission, Kuwait. JH was funded by NIHR Surgical Reconstruction and Microbiology Research centre, UK. The funders had no role in the study design, data collection, data analysis, data interpretation, drafting the report, or decision to submit the manuscript for publication. Ethical approval for the SIFTI study was granted by the National Research Ethics Service Committee East Midlands, UK (Reference 12/EM/0432). KA, NM, JML, YW, and TT were responsible for the conception and design of this study. KA, PT, and JH contributed to data collection. KA, AA, and BT conducted the statistical analyses. All authors contributed to data interpretation and manuscript preparation. All authors critically reviewed and approved the final version. All authors had full access to all the data in the study and had final responsibility for the decision to submit for publication. The manuscript was prepared according to STROBE guidelines. We thank all the study participants and their families, as well as the clinical research nurses and fellows for their support in this study. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.

Keywords

  • Corticosteroids
  • Oxandrolone
  • Mortality
  • Multiorgan failure
  • Sepsis
  • Burns
  • Multi-organ failure

ASJC Scopus subject areas

  • Surgery

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