Nutrition Interventions in Older Adult Burn Patients: The Stratification of Albumin Level

Older adult patients often present with malnutrition, which is associated with increased morbidity and mortality after burn injury. This multicenter retrospective cohort study assessed outcomes in older adult burn patients (≥60 years) presenting to 12 burn centers in the US and Canada. Patients were stratified by nutritional status (nourished: admission albumin ≥3.0 g/dL; malnourished: admission albumin <3 g/dL) with further subgrouping by albumin level (1-1.9, 2-2.9, 3-3.9, 4+). A mixed effect generalized linear model controlling for admitting center was fit to assess the adjusted odds of in-hospital mortality and complications. About 712 patients met inclusion criteria, 442 in the nourished cohort and 270 in the malnourished cohort. On multivariable analysis, the binary classification of albumin was not significantly associated with morbidity or mortality. However, when treating albumin as continuous, levels were highly associated with mortality and select complications, with every one point increase in admission albumin lowering the odds of death by 54% (aOR 0.46, 95% CI, 0.26, 0.81), the odds of multiple organ failure by 59% (aOR 0.41, 95% CI, 0.20, 0.85) and the odds of intensive care unit delirium by 54% (aOR 0.46, 95% CI, 0.23, 0.95). Admission albumin levels are highly associated with morbidity and mortality in older adult burn patients and appear to be a readily available useful indicator of outcomes.