Prediction of clinical outcome with serum transthyretin level of early post-burn period in massive burn patients: retrospective observational study

Introduction: We observed serum transthyretin (TTR) constantly maintained low even with adequate nutritional support if the patients’ general conditions are poor. We conducted this study to analyze the change of serum TTR with time from injury in massive burn patient and verify the validity of prediction of clinical outcome with serum TTR of early post-burn period. Methods: From January of 2005 to December of 2010, serum TTR of 471 burn patients (% total body surface area (TBSA) burned, mean 51±20%) analyzed with time from injury retrospectively. Results: Serum TTR decreased significantly during period of day 5 to 10 after the injury in both survivors (n = 290, mean %TBSA burned 42.9±14.2%) and non-survivors (n = 181, mean %TBSA burned 64.6±20.8%). After this period, the serum TTR constantly increased in survivors, however, remained low in non-survivors. At all time, serum TTR levels of survivors were significantly higher than non-survivors (1-4 day, P = 0.019; 5-10 day, P = 0.019; 11-20 day, P = 0.000, 21-30 day, P = 0.000; 31-40 day, P = 0.000). The serum TTR had weak correlation with the extent of the burn injury (r = -0.234). Survival rates of the patients increased significantly by the increase of the serum TTR of early post-burn period (1-10 day, P = 0.000; 1-4 day, P = 0.003; 5-10 day, P = 0.001). Conclusions: The serum TTR of early post burn period can be used as a prognostic indicator. And low serum TTR is a signal for screening the patient at risk who requires careful assessment and monitoring in massive burn patient. So it can be a useful option to measure the serum TTR level periodically in massive burn patients.