(1230) Does COVID-19 Infection With Inhalation Injury Increase Mortality Risk in Burn Patients?

Introduction: In the burn patient population, the presence of an inhalation injury is associated with an increased risk of mortality, upwards of 20%. The inflammatory cascade brought on by inhalation of smoke or chemicals contributes to the burden for the burn patient, and we now know that COVID-19 creates significant inflammatory changes to the pulmonary structures. We sought to evaluate the impact of an acute COVID infection, either on admission or acquired during their hospitalization, on the outcomes of a burn patient with an inhalation injury.

Methods: Patients admitted to the burn service from March 2020 to April 2024 were identified using the Institutional Burn Center registry and linked to the clinical and administrative data. Active COVID-19 was defined as having an active COVID-19 diagnosis during the patient’s hospital stay (exposed) or not having an active COVID-19 diagnosis during the patient’s hospital stay (unexposed). Eleven covariates were included in the analysis. Propensity score matching accounted for seven confounders with comparison of standardized mean differences pre- and post-PS weighting.

Results: There were 2768 patients admitted during this time. Inhalation injury was present in 83 patients (3%), absent in 2661 (96.4%) patients, with missing data for 24 patients. Of the total, 91 patients (3.28%) met criteria for acute COVID-19 while 2677 patients (96.7%) did not meet the criteria for active infection. There were 7 (7.7%) patients with both inhalation injury and met criteria for active COVID-19 infection. Among those with inhalation injury, results are not statistically significant, and the RR is < 1.0 (RR: 0.2554, 95% CI: 0.0334, 1.9515, p=0.1883) suggests lower but non statistically significant mortality risk in COVID patients.

Conclusions: In a standard burn mortality predictor, presence of an inhalation injury can increase odds of mortality as much as 20%. Adjusting for confounders, the implication of COVID-19 infection far outweighs the harm caused by inhalation injury in our patients, demonstrating a concerning trend. While we have made great strides in treating burn patients with inhalation injury and managing their pulmonary complications, the COVID-19 virus has created a new challenge for these patients that warrants further consideration.