Gastrointestinal insufficiency is a risk factor for severely burned patients: a case-control study among 185 victims in Kunshan explosion

The Kunshan explosion in 2014 brought about massive casualties and injuries. Gastrointestinal (GI) insufficiency secondary to burn injuries was one of the most critical risk factors. However, the impact of GI insufficiency on burn patients’ survival from the Kunshan explosion remained unclear. Therefore, our study aimed at illustrating how GI insufficiency contributed to all-cause mortality and interacted with other clinical characteristics. The hypothesis was proposed that GI insufficiency functioned as a risk factor for severely burned patients. A case-control study was conducted to include 185 burn victims. Kaplan-Meier (K-M) survival analysis was utilized to compare the overall survival (OS) between severely burned patients with and without GI insufficiency. Furthermore, multivariate Cox regression analysis was deployed to evaluate the impact of GI insufficiency on patients’ prognosis, followed by a predictive model constructed. Meanwhile, multiple subgroup analysis was performed to uncover the clinical interaction. Finally, the similar statistical methods were applied on an external validation cohort of Changhai Hospital for further investigation. K-M analysis showed a statistical significance of OS between severely burned patients with and without GI insufficiency (p < 0.001). Multivariate Cox regression analysis also demonstrated GI insufficiency functioned as a risk factor to burn patients’ survival (Hazard Rate HR = 1.7, p = 0.046). Chi-square test in subgroup analysis indicated “GI bleeding”, “organ dysfunction”, “acute kidney injury (AKI)”, “disseminated intravascular coagulation (DIC)”, “deep vein catheterization” and “hemodialysis” were all statistically significant. The multivariate Cox regression analysis results of external validation (HR = 2.78, p < 0.001) coordinated with Kunshan cohort. GI insufficiency was a risk factor for severely burned patients. There was an urgent need for more effective strategies to prevent and manage GI insufficiency and relevant complications in severely burned population.