Does burn trauma increase the risk of death and rehospitalization for cardiovascular causes?

Abstract Introduction Burn injury has been shown to trigger hypermetabolic reactions within the body, which have been observed to persist for extended periods, potentially exerting deleterious effects on the cardiovascular system. Purpose The objective of this study was to assess the long-term cardiovascular outcomes of a substantial cohort of patients from the high-volume burn centres enrolled in a registry. Methods The registry comprised unselected in-patient subjects from the two largest burn centres in the Czech Republic over a 15-year period (2000-2015). The acquisition of data pertaining to mortality, cardiovascular mortality and rehospitalization was conducted in conjunction with the Institute of Health Information and Statistics of the Czech Republic (date of censoring was November 6, 2023). Patients were divided into groups by age (35; 35-50; ≥50 years) and by total body surface area (TBSA) extent of burn (10 %; 10-19 %; 20-39 %; ≥40 %). Five- and ten-years relative survival rate (RSR) compared to general population was calculated with 95% confidential interval (CI). The number of hospitalization events occurring during the study period was expressed in person-years and comparison between groups was assessed. Results In this cohort study, 7048 patients were analysed and classified according to burn severity, measured by TBSA affected. The average follow-up period was 13.2 years, during which 1582 (22.4 %) patients died. All-cause mortality according to TBSA (10 %, 10-19 %, 20-39 %, ≥40 %) was 21.6 %, 22.3 %, 21.8 % and 33.2 %, respectively. The leading cause of mortality were cardiovascular diseases, responsible for 580 deaths (36.7 %). Cardiovascular mortality according to TBSA was 9.0 %, 8.0 %, 7.7 % and 2.4 %, respectively. The most common cardiovascular causes of death were chronic ischemic heart disease (n=204, 35.2 %), heart failure (n=76, 13.1 %) and acute myocardial infarction (n=60, 10.3 %). Cardiovascular mortality was age-dependent, with the highest mortality in the age group 50 years (19.6 %). A total of 3006 hospitalizations for cardiovascular related causes were recorded over the study period. The rate of rehospitalization for cardiovascular condition increased progressively with advancing age but remained consistent across TBSA groups (10 %; 10-19 %; 20-39 %). The lowest rate of rehospitalization for cardiovascular causes was present in group of severe (≥40 % TBSA) burn injury (relative risk 0.60 (0.48; 0.75), p 0.001). Conclusion Cardiovascular mortality and rehospitalization for cardiovascular causes do not correlate with the severity of burn injury, with lowest rates observed in severely burn-injured patients probably due to the high mortality from injuries and other external causes. It appears that burn injury does not worsen cardiovascular outcomes in this specific population.Probability of death by extent of burn Probability of death by age group