Hematological Biomarkers at Admission as Predictors of Outcome in Severe Burns: Experience From a South Indian Tertiary Care Hospital.

Abstract

Background: Burns are associated with significant morbidity and mortality, with several factors determining mortality. Identifying reliable early predictors of mortality is crucial for guiding treatment decisions and improving outcomes. This study evaluates the prognostic significance of neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in predicting mortality in patients with severe burns.

Methods: A retrospective study was conducted on 91 adult patients (aged ≥18 years) with severe burns (TBSA ≥20%) admitted within 48 hours of injury. Clinical, etiological, and laboratory parameters were analyzed. Receiver operating characteristic (ROC) curve analysis was used to determine the predictive value of NLR, PLR, and total body surface area (TBSA) for mortality, with the area under the curve (AUC) indicating their discriminative ability.

Results: The mean age of the cohort was 47.6 years (range: 18-89 years), with a male predominance (57.1%). Thermal burns were the most common etiology (86.8%), followed by electrical burns (11%) and chemical burns (2.2%). The median TBSA of the entire cohort was 42%, of which nonsurvivors had significantly higher median TBSA involvement (52% vs 30%, P = 0.0005) and median duration of hospitalization (DOH) (4 vs 23 days, P = 0.0005). The mean NLR was significantly higher in nonsurvivors (15.2 vs 8.4, P = 0.005). ROC curve analysis identified an optimal NLR cutoff value of 8.19 (AUC = 0.614, 95% CI: 0.497-0.731, P = 0.061) with 56.5% sensitivity and 55.6% specificity. The optimal PLR cutoff value was 186.57 (AUC = 0.461, 95% CI: 0.341-0.581, P = 0.520) with 50% sensitivity and 51% specificity. TBSA cutoff value of 41% was strongly associated with mortality (AUC = 0.86, 95% C.I: 0.781-0.940, P = 0.0005), with 82.6% sensitivity and 77.8% specificity.

Conclusions: Higher TBSA involvement and elevated NLR are significant predictors of mortality in severe burn patients. Although TBSA >41% is the most reliable prognostic indicator, PLR did not show significant predictive value. Early assessment of these parameters may aid in risk stratification and management of burn patients.