Incidence of Copper Deficiency and Adequacy of Repletion in Patients With Significant Burn Injuries

Introduction: Copper (Cu) deficiency can result in poor wound healing, anemia, neuropathies, and arrhythmias. Deficiency has been noted due to high exudative copper losses in patients with burn injuries. Because serum Cu is increased during inflammation, the European Society for Clinical Nutrition and Metabolism recommends obtaining C-reactive protein (CRP) with Cu levels to guide interpretation in critically ill patients. Specific guidance on routine monitoring for Cu deficiency in critically ill with burn injuries is lacking. Our burn ICU does not have a formal Cu monitoring protocol but generally orders Cu levels in patients with >20% total body surface area (TBSA) burns or if malnutrition is present. The purpose of this study is to evaluate the incidence of Cu deficiency in patients with burn injuries.


Methods: This retrospective review evaluated adults (≥18 years) admitted to the burn unit at a large academic medical center from January to December 2023 with least 1 Cu level. The primary outcome was overall incidence of Cu deficiency ( < 70 mcg/dL for men, < 80 mcg/dL for women or < 100 mcg/dL in either sex if CRP >20 mg/L). Secondary outcomes were incidence of Cu deficiency without accounting for CRP and incidence of confirmed resolution of deficiency. Data were analyzed with descriptive statistics and presented as median (IQR) or percentages.


Results: Fifty-one patients were included (64.7% male) with a median age of 48 (35-65) years, 24.1 (11.9-30.5) % TBSA, and initial Cu concentration 81.4 (68.2-101.2) mcg/dL. Deficiency was present in 69% of patients (based on Cu + CRP levels; men 64%, women 78%) and 37% of patients based on Cu level alone. Deficiency resolved in 51% of patients after oral and/or IV Cu repletion.


Conclusions: Copper deficiency occurred frequently in patients with significant burn injuries. Evaluation of CRP along with Cu concentration is imperative, as 32% of patients with Cu deficiency would not have been correctly diagnosed without CRP. Deficiency was not resolved in 49% of patients, though some were discharged prior to repeat Cu levels. These results underscore the need for a standardized practice guideline for the monitoring and management of Cu deficiency in patients with burn injuries.