Clinical outcomes associated with prior glucagon-like peptide-1 receptor agonist exposure in burned patients

Glucagon-like peptide-1 (GLP-1) receptor agonists have anti-inflammatory and immunomodulatory properties beyond glycaemic control. The impact of GLP-1 receptor agonists on burn injury outcomes remains unexplored. The aim of this study was to assess the potential impact of prior GLP-1 receptor agonist exposure on mortality, infectious complications, and critical care utilization in burn patients.

Using the TriNetX US Collaborative Network, adult patients with thermal burns ≤20% total body surface area (TBSA) between 1 January 2018 and 8 November 2025 were identified. Patients with documented GLP-1 receptor agonist use within 1 year before burn injury were propensity score matched with controls for age, sex, race, co-morbidities, TBSA, BMI, and haemoglobin A1c (HbA1c). Outcomes included 1-year mortality, infectious complications, critical care utilization, and wound management outcomes. Sensitivity analyses examined 6-month and 3-year exposure windows.

After matching, 8307 patients per cohort were included. GLP-1 receptor agonist exposure was associated with 54% reduced odds of mortality (OR 0.46, P < 0.001), 35% reduced intensive care unit admission (OR 0.65, P < 0.001), and 62% reduced intubation (OR 0.38, P < 0.001). Infectious complications were significantly decreased, including sepsis (32% reduction), pneumonia (24% reduction), and methicillin-resistant Staphylococcus aureus (MRSA) infection (27% reduction). The odds of broad-spectrum antibiotic use decreased 21%. Benefits persisted across all exposure windows. The 3-year cohort demonstrated a 27% increase in hypertrophic scarring (OR 1.27, P = 0.031).

Prior GLP-1 receptor agonist use was associated with a significant decrease in mortality, infectious complications, and critical care utilization among burn patients, independent of metabolic factors like BMI. These findings warrant prospective studies to optimize perioperative management strategies in this patient population.