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505 Burn Sepsis: Does the Initial Vitamin C Level Matter?


 
 
 After the first 24 hours, the principle cause of death in burn patients is multiple organ dysfunction/failure syndrome. It is preceded by infection in 83% of burn patients, with reported septic mortality up to 65%. In a recent journal article involving septic medical ICU patients, Marik et al. reports that all initial Vitamin C levels were below the normal range (0.4–2.0 mg/dL) prior to any intervention. Independent of each other, both early recognition and treatment of infection and vitamin C have been shown to be beneficial in sepsis. We monitored Vitamin C levels as part of our “Burn Code Sepsis” algorithm to obtain a baseline understanding of Vitamin C levels in infected adult burn patients.
 
 
 
 Adult (≥18 yo) admissions between 7/1/2018 – 6/30/2019 were identified from our Burn Registry and all sepsis screens were evaluated in the EMR. Patients were screened clinically at least BID and were considered a “positive” screen if MAP < 65 mmHg (SBP< 90 mmHg) or if 2 of the 3 occurred: Temp >102.2F; HR >120; RR >28 (or RR >10% of ventilator set rate if set rate is >24 bpm). A positive screen prompted lab work to include CBC, BMP, procalcitonin (PCT), lactic acid (LA) and Vitamin C (VC), per protocol. If PCT >3.0 ng/ml or LA >2.0 mmol/L, or both thrombocytopenia and hyperglycemia were present, a “Burn Code Sepsis” was initiated and included cultures, a CXR, and empiric antibiotics. If the cultures were positive or the CXR demonstrated an infectious process, a patient was considered “septic”. All burn injured patients with greater than or equal to 20% TBSA burns receive Vitamin C supplementation as part of our standard of care.
 
 
 
 There were 286 admissions during the 12-month period, with 38 positive initial sepsis screens (mean TBSA = 35%) that have an associated VC level. Of these positive screens, 26 (65%) were infected and 12 (35%) were not infected. ROC Curve analysis of VC levels and its ability to diagnose septic patients yields an AUC = 0.60 (p = 0.37). The mean VC level of infected patients at the time of initial screening was 1.9 +/- 1.4 mg/dL, and the mean VC level of non-infected patients at initial screening was 1.5 +/- 1.0 mg/dL.
 
 
 
 Our results contrast with the previously published article on Vitamin C levels in a septic, non-burn injured population. Only 1 of 26 infected patients possessed a Vitamin C level below the normal range (0.4–2.0 mg/dL). Infected patients possessed higher Vitamin C levels than the non-infected patients, though not statistically significant (p = 0.35). AUC analysis indicates Vitamin C level is a poor prognostic test for sepsis.
 
 
 
 Further research on Vitamin C levels and Its role in sepsis in the burn injured population is warranted.
