Body mass index as a predictor of severity in burn injury: a retrospective analytical study
DOI:
https://doi.org/10.18203/2349-2902.isj20253761Keywords:
Burn injury, Body mass index, Obesity, Severity index, Prognosis, MortalityAbstract
Background: Obesity has been identified as an independent risk factor influencing outcomes in trauma and critical illness. In burn patients, excess weight may exacerbate metabolic demand, impair wound healing, and increase mortality. Objective of the study was to determine whether body mass index (BMI) serves as a predictor of severity in hospitalized burn patients and to assess whether incorporating BMI into the abbreviated burn severity index (ABSI) improves its prognostic accuracy.
Methods: A retrospective, analytical, and cross-sectional study was conducted at the Burn and Intensive Care Units of the “Dr. Victorio de la Fuente Narváez” Hospital, Instituto Mexicano del Seguro Social (IMSS), from January 2016 to January 2020. Clinical records were reviewed to obtain demographic, anthropometric, and clinical data. Sensitivity and specificity analyses were performed to determine the optimal BMI cutoff for mortality prediction.
Results: Seventy adult burn patients met inclusion criteria. The mean BMI among survivors was 26.7±3.9 kg/m² and among non-survivors 30.5±4.9 kg/m² (p=0.03). A BMI cutoff of 28 kg/m² yielded an AUC of 0.748 (95% CI 0.68-0.88; p=0.003), with 0.80 sensitivity and 0.69 specificity for mortality prediction. Mortality was significantly higher among patients with BMI ≥28 kg/m² (80%) compared to those below this threshold (32.7%; p=0.0003). The standard ABSI system maintained high predictive accuracy (sensitivity=86.6%, specificity=100%).
Conclusions: BMI ≥28 kg/m² adversely affects survival in adult burn patients. Although the ABSI remains a highly accurate tool, incorporating BMI could enhance its prognostic power.
Metrics
References
Porter C, Herndon DN, Borsheim E, Chao T, Reidy PT, Borack MS, et al. Uncoupled skeletal muscle mitochondria contribute to hypermetabolism in severely burned adults. Am J Physiol Endocrinol Metab. 2014;307(5):E479-87. DOI: https://doi.org/10.1152/ajpendo.00206.2014
Sheridan RL, Rue LW 3rd, McManus WF, Pruitt BA Jr. Burns in morbidly obese patients. J Trauma. 1992;33(6):818-20. DOI: https://doi.org/10.1097/00005373-199212000-00004
Cromwell PM, Reynolds IS, Heneghan HM, Glasgow SM. Obesity and outcomes in trauma - a systematic review and meta-analysis. Injury. 2023;54(2):469-80. DOI: https://doi.org/10.1016/j.injury.2022.10.026
Sayampanathan AA. Systematic review and meta-analysis of complications and outcomes of obese patients with burns. Burns. 2016;42(8):1634-43. DOI: https://doi.org/10.1016/j.burns.2016.05.008
Borrell LN, Samuel L. Body mass index categories and mortality risk in US adults: the effect of overweight and obesity on advancing death. Am J Public Health. 2014;104(3):512-9. DOI: https://doi.org/10.2105/AJPH.2013.301597
Tobiasen J, Hiebert JM, Edlich RF. The Abbreviated Burn Severity Index. Ann Emerg Med. 1982;11(5):260-2. DOI: https://doi.org/10.1016/S0196-0644(82)80096-6
Christ A, Staud CJ, Krotka P, Resch A, Neumüller A, Radtke C. Revalidating the prognostic relevance of the Abbreviated Burn Severity Index (ABSI): A twenty-year experience examining the performance of the ABSI score in consideration of progression and advantages of burn treatments from a single center in Vienna. J Plast Reconstr Aesthet Surg. 2024;94:160-8. DOI: https://doi.org/10.1016/j.bjps.2024.04.041
Mrad MA, Al Qurashi AA, Shah Mardan QNM, Al Jabr FA, Almenhali AA, Bamakhrama B, et al. Risk Models to Predict Mortality in Burn Patients: A Systematic Review and Meta-analysis. Plast Reconstr Surg Glob Open. 2022;10(12):e4694. DOI: https://doi.org/10.1097/GOX.0000000000004694
Liodaki E, Senyaman Ö, Stollwerck PL, Möllmeier D, Mauss KL, Mailänder P, Stang F. Obese patients in a burn care unit: a major challenge. Burns. 2014;40(8):1738-42. DOI: https://doi.org/10.1016/j.burns.2014.04.016
Pauzenberger R, Radtke C, Ederer IA, Hacker S, Waldmann A, Sternat N, et al. Does obesity impact the outcome of severely burned patients? Int Wound J. 2020;17(2):380-6. DOI: https://doi.org/10.1111/iwj.13282
Ayalon I, Bodilly L, Kaplan J. The Impact of Obesity on Critical Illnesses. Shock. 2021;56(5):691-700. DOI: https://doi.org/10.1097/SHK.0000000000001821
Dhanasekara CS, Cole TJ, Bayouth J, Shaw C, Dissanaike S. Impact of elevated body mass index on burn injury-associated mortality in a representative US sample. Surgery. 2023;173(6):1508-12. DOI: https://doi.org/10.1016/j.surg.2023.02.014
Yazıcı H, Uçar AD, Namdaroğlu O, Yıldırım M. Mortality prediction models for severe burn patients: Which one is the best? Ulus Travma Acil Cerrahi Derg. 2022;28(6):790-5. DOI: https://doi.org/10.14744/tjtes.2021.29540
Saadat GH, Toor R, Mazhar F, Bajani F, Tatebe L, Schlanser V, et al. Severe burn injury: Body Mass Index and the Baux score. Burns. 2021;47(1):72-7. DOI: https://doi.org/10.1016/j.burns.2020.10.017
Tolley PD, McClellan JM, Butler D, Stewart BT, Pham TN, Sheckter CC. Burn Outcomes at Extremes of Body Mass Index: Underweight Is as Problematic as Morbid Obesity. J Burn Care Res. 2022;43(5):1180-5. DOI: https://doi.org/10.1093/jbcr/irac014
Downloads
Published
How to Cite
Issue
Section
