Revised Baux score as a tool to identify the subset of adult burn patients that show survival benefit with enteral glutamine supplementation

Glutamine supplementation is thought to enhance outcomes in burn injury due to its multifold activity in modulating the immune and inflammatory response. However, the survival benefit offered by it is sometimes debated. Through this study, we attempt to classify burns patients based on the predicted mortality risk given by the revised Baux score, and evaluate the difference in survival with glutamine supplementation. A total of 60 patients with age between 18 and 60 years and revised Baux score (rBS) of 40-120 at admission were randomly allocated to two groups of 30 subjects each. The control group received standard nutritional supplementation, while the test group received 0.3g/kg/day of enteral glutamine additionally. The subjects were sub-divided into 4 groups based on their rBS, and mortality compared in each group. The average rBS of subjects among the test and control groups were 79.36 and 80.2 respectively. There were 6 deaths seen in the glutamine group - 2 (25%) among patients in group C (rBS of 81-100) and 4 (80%) among patients in group D (101-120), as opposed to 10 deaths in the control group- 4(44%) and 6 (100%) deaths in groups C and D respectively. A statistically significant (p= 0.007) reduction in the duration of hospitalization was noted in the group with rBS of 81-100 and glutamine supplementation. Prophylactic enteral glutamine supplementation in patients with revised Baux scores between 81-100 appears to reduce the mortality and duration of hospitalization, whereas the benefit seems to be insignificant in patients with revised Baux scores of less than 80 and over 100.