Admission Carboxyhemoglobin: Is It a Marker for Burn Patient Outcomes?

Area of Science:

• Toxicology
• Burn Medicine
• Critical Care Medicine

Background:

• Carbon monoxide (CO) binds to heme molecules with high affinity, forming carboxyhemoglobin (COHb).
• Elevated COHb impairs oxygen transport, potentially worsening outcomes in burn patients.
• COHb levels on admission may serve as a prognostic indicator for burn injury severity.

Purpose of the Study:

• To evaluate the association between elevated carboxyhemoglobin (COHb) levels on admission and patient outcomes in burn injuries.
• To determine if initial COHb is a predictor of mortality, length of stay, and resource utilization in burn patients.

Main Methods:

• A 10-year retrospective review (2002-2011) of the American Burn Association Burn Registry.
• Stratification of 6365 burn patients into normal (<10%) versus elevated (>10%) COHb groups on admission.
• Analysis of in-hospital mortality, hospital length of stay (LOS), ICU-LOS, and ventilator days using statistical tests (χ and t tests).

Main Results:

• Patients with elevated COHb (>10%) had significantly longer hospital LOS (15.34 vs 9.66 days) and ICU-LOS (12.89 vs 4.01 days).
• Elevated COHb was associated with higher average ventilator days (9.23 vs 2.05 days) and a substantially increased in-hospital mortality rate (15.59% vs 1.33%).
• No significant difference in full-thickness burn surface area between groups, though partial thickness burns were higher in the normal COHb group.

Conclusions:

• Elevated carboxyhemoglobin on admission is a significant predictor of adverse outcomes in burn patients.
• Higher COHb levels correlate with increased hospital resource utilization, including longer ICU stays and mechanical ventilation.
• Initial COHb assessment can identify burn patients at higher risk for poor prognosis and increased healthcare needs.