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Article Navigation >  CHINESE JOURNAL OF BURNS AND WOUNDS  >  > Accepted Manuscript
Sun Ranran,Lang Jingyuan,Gao Shijie,et al.Analysis of the relationship between albumin balance status during the shock phase and MODS in patients with severe burns and the risk factors for the occurrence of negative albumin balance[J].Chin J Burns Wounds,2026,42(10):1-9.DOI: 10.3760/cma.j.cn501225-20250616-00268.
Citation: Sun Ranran,Lang Jingyuan,Gao Shijie,et al.Analysis of the relationship between albumin balance status during the shock phase and MODS in patients with severe burns and the risk factors for the occurrence of negative albumin balance[J].Chin J Burns Wounds,2026,42(10):1-9.DOI: 10.3760/cma.j.cn501225-20250616-00268.
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Analysis of the relationship between albumin balance status during the shock phase and MODS in patients with severe burns and the risk factors for the occurrence of negative albumin balance

doi: 10.3760/cma.j.cn501225-20250616-00268

  • Institute of Burn Research, State Key Laboratory of Trauma and Chemical Poisoning, the First Affiliated Hospital of Army Medical University (the Third Military Medical University), Chongqing 400038, China

Funds:

Major Project of the Clinical Research Incubation Program of the First Affiliated Hospital of Army Medical University 2024IITZDA01

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  • Corresponding author: Luo Gaoxing, Email: logxw@tmmu.edu.cn
  • Received Date: 2025-06-16
    Available Online: 2026-10-16
    Abstract
  •   Objective  To analyse the relationship between albumin balance status during the shock phase and multiple organ dysfunction syndrome (MODS) in patients with severe burns and the risk factors for the occurrence of negative albumin balance.  Methods  This study was a retrospective case series study. From January 1st, 2023 to December 31st, 2024, 89 patients with severe burns who met the inclusion criteria were admitted to the First Affiliated Hospital of Army Medical University (Third Military Medical University), including 73 males and 16 females, aged (48±14) years. The albumin level at admission was collected, and blood volume and plasma volume were estimated based on the Nadler formula, with attenuation correction using the metabolic half-lives of exogenous and endogenous albumin, the albumin balance value at 48 h post-injury was calculated. Patients with an albumin balance value of ≤0 g/L at 48 h post-injury were included in negative balance group (n=14), while those with an albumin value of >0 g/L were included in positive balance group (n=75). The two groups were compared in terms of burn severity indicators such as total burn area and full-thickness burn area; inflammatory indicators at 48 h post-injury such as the neutrophil percentage-to-albumin ratio (NPAR), aggregate index of systemic inflammation (AISI), systemic inflammation response index (SIRI), systemic immune-inflammation index (SII), neutrophil-to-lymphocyte ratio (NLR), and monocyte-to-lymphocyte ratio (MLR); and organ injury indicators at 48 h post-injury such as the modified sequential organ failure assessment (SOFA) score and the incidence of MODS. The independent risk factors for the occurrence of negative albumin balance at 48 h post-injury in patients with severe burns were screened.  Results  In the 89 patients, the albumin level at admission was (28±7) g/L and the albumin balance value at 48 h post-injury was 9.01 (3.06, 19.62) g/L, with 15.73% (14/89) of the patients developing negative albumin balance. The albumin level at admission was significantly positively correlated with the albumin balance value at 48 h post-injury (rs=0.349, P<0.05). There were statistically significant differences between patients in negative balance group and positive balance group in terms of total burn area, full-thickness burn area, and AISI, SIRI, SII, NPAR, MLR, modified SOFA score and percentage of patients with MODS at 48 h post-injury (with Z values of -3.736, -4.096, -2.310, -2.186, -2.130, -3.629, -2.108, and -2.597, χ2=11.168, respectively, P<0.05). Univariate logistic regression analysis results showed that total burn area, full-thickness burn area, and NPAR, AISI, SIRI, SII, NLR, MLR, and modified SOFA score at 48 h post-injury were the risk factors for the occurrence of negative albumin balance at 48 h post-injury in patients with severe burns (with ORs of 1.061, 1.053, 1.116, 1.003, 1.240, 2.073, 1.082, 3.810 and 1.283, respectively, 95% CIs of 1.028-1.094, 1.025-1.081, 1.045-1.191, 1.001-1.004, 1.093-1.407, 1.227-3.501, 1.020-1.147, 1.627-8.923, and 1.065-1.546, respectively, P<0.05). Multivariate logistic regression analysis results showed that full-thickness burn area and SII at 48 h post-injury were the independent risk factors for the occurrence of negative albumin balance at 48 h post-injury in patients with severe burns (with ORs of 1.056 and 2.321, respectively, 95% CIs of 1.015-1.099 and 1.185-4.549, respectively, P<0.05).  Conclusions  Negative albumin balance during the shock phase was closely associated with the incidence of MODS in patients with severe burns, with full-thickness burn area and SII at 48 h post-injury were the independent risk factors for the occurrence of negative albumin balance.

     

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    • References(40)
  • [1]
    JeschkeMG,van BaarME,ChoudhryMA,et al.Burn injury[J].Nat Rev Dis Primers,2020,6(1):11.DOI: 10.1038/s41572-020-0145-5.
    [2]
    中国老年医学学会烧创伤分会.烧伤休克防治全国专家共识(2020版)[J].中华烧伤杂志,2020,36(9):786-792.DOI: 10.3760/cma.j.cn501120-20200623-00323.
    [3]
    CartottoR, JohnsonLS, SavetamalA, et al. American Burn Association Clinical Practice Guidelines on burn shock resuscitation[J]. J Burn Care Res,2024,45(3):565-589.DOI: 10.1093/jbcr/irad125.
    [4]
    HaberalM, Sakallioglu AbaliAE, KarakayaliH. Fluid management in major burn injuries[J]. Indian J Plast Surg,2010,43(Suppl):S29-S36.DOI: 10.4103/0970-0358.70715.
    [5]
    DemlingRH.The incidence and impact of pre-existing protein energy malnutrition on outcome in the elderly burn patient population[J].J Burn Care Rehabil,2005,26(1):94-100.DOI: 10.1097/01.bcr.0000150302.71007.80.
    [6]
    LehnhardtM,JafariHJ,DrueckeD,et al.A qualitative and quantitative analysis of protein loss in human burn wounds[J].Burns,2005,31(2):159-167.DOI: 10.1016/j.burns.2004.08.015.
    [7]
    SoetersPB, WolfeRR, ShenkinA. Hypoalbuminemia: pathogenesis and clinical significance[J]. JPEN J Parenter Enteral Nutr,2019,43(2):181-193.DOI: 10.1002/jpen.1451.
    [8]
    ChenYF, MaH, PerngCK, et al. Albumin supplementation may have limited effects on prolonged hypoalbuminemia in major burn patients: an outcome and prognostic factor analysis[J]. J Chin Med Assoc,2020,83(2):206-210.DOI: 10.1097/JCMA.0000000000000245.
    [9]
    CooperAB,CohnSM,ZhangHS,et al.Five percent albumin for adult burn shock resuscitation: lack of effect on daily multiple organ dysfunction score[J].Transfusion,2006,46(1):80-89.DOI: 10.1111/j.1537-2995.2005.00667.x.
    [10]
    LambdenS,LaterrePF,LevyMM,et al.The SOFA score-development, utility and challenges of accurate assessment in clinical trials[J].Crit Care,2019,23(1):374.DOI: 10.1186/s13054-019-2663-7.
    [11]
    NavickisRJ, GreenhalghDG, WilkesMM. Albumin in burn shock resuscitation: a meta-analysis of controlled clinical studies[J]. J Burn Care Res,2016,37(3):e268-e278.DOI: 10.1097/BCR.0000000000000201.
    [12]
    ZdolsekM,HahnRG,SjöbergF,et al.Plasma volume expansion and capillary leakage of 20% albumin in burned patients and volunteers[J].Crit Care,2020,24(1):191.DOI: 10.1186/s13054-020-02855-0.
    [13]
    HasselgrenE, ZdolsekM, ZdolsekJH, et al. Long intravascular persistence of 20% albumin in postoperative patients[J]. Anesth Analg,2019,129(5):1232-1239.DOI: 10.1213/ANE.0000000000004047.
    [14]
    SharmaHK, PageSS. Protein deficiency and related metabolic disturbances and its effects on drug metabolism in patients with burns[J]. Indian J Burns,2024,32(1):1-6.DOI: 10.4103/ijb.ijb_1_24.
    [15]
    SaraviB,GoebelU,HassenzahlLO,et al.Capillary leak and endothelial permeability in critically ill patients: a current overview[J].Intensive Care Med Exp,2023,11(1):96.DOI: 10.1186/s40635-023-00582-8.
    [16]
    OhWS, ChonSB. Calculation of the residual blood volume after acute, non-ongoing hemorrhage using serial hematocrit measurements and the volume of isotonic fluid infused: theoretical hypothesis generating study[J]. J Korean Med Sci,2016,31(5):814-816.DOI: 10.3346/jkms.2016.31.5.814.
    [17]
    LevittDG,LevittMD.Human serum albumin homeostasis: a new look at the roles of synthesis, catabolism, renal and gastrointestinal excretion, and the clinical value of serum albumin measurements[J].Int J Gen Med,2016,9:229-255.DOI: 10.2147/IJGM.S102819.
    [18]
    吴军,罗高兴. 烧伤免疫研究进展[J]. 中华烧伤杂志,2004,20(6):321-323.DOI: 10.3760/cma.j.issn.1009-2587.2004.06.101.
    [19]
    VincentJL,DuboisMJ,NavickisRJ,et al.Hypoalbuminemia in acute illness: is there a rationale for intervention? A meta-analysis of cohort studies and controlled trials[J].Ann Surg,2003,237(3):319-334.DOI: 10.1097/01.SLA.0000055547.93484.87.
    [20]
    YeTTS, VishnuK S, DahilA, et al. Serum albumin on admission: a prognostic marker of morbidity and mortality in burns? A systematic review and meta-analysis[J]. J Burn Care Res,2026,47(5):1530-1542.DOI: 10.1093/jbcr/irag092.
    [21]
    BandeiraNG, BarrosoMVVS, MatosMAA, et al. Serum albumin concentration on admission as a predictor of morbidity and mortality in patients with burn injuries[J]. J Burn Care Res,2021,42(5):991-997.DOI: 10.1093/jbcr/irab004.
    [22]
    NadlerSB,HidalgoJH,BlochT.Prediction of blood volume in normal human adults[J].Surgery,1962,51(2):224-232.
    [23]
    WangB,ChenG,CaoY,et al.Correlation of lactate/albumin ratio level to organ failure and mortality in severe sepsis and septic shock[J].J Crit Care,2015,30(2):271-275.DOI: 10.1016/j.jcrc.2014.10.030.
    [24]
    DeitchEA.Intestinal permeability is increased in burn patients shortly after injury[J].Surgery,1990,107(4):411-416.
    [25]
    SingerM, DeutschmanCS, SeymourCW, et al. The third international consensus definitions for sepsis and septic shock (Sepsis-3)[J]. JAMA,2016,315(8):801-810.DOI: 10.1001/jama.2016.0287.
    [26]
    WeissSJ.Tissue destruction by neutrophils[J].N Engl J Med,1989,320(6):365-376.DOI: 10.1056/NEJM198902093200606.
    [27]
    FerreiraFL,BotaDP,BrossA,et al.Serial evaluation of the SOFA score to predict outcome in critically ill patients[J].JAMA,2001,286(14):1754-1758.DOI: 10.1001/jama.286.14.1754.
    [28]
    LiF,HeQ,PengH,et al.The systemic inflammation indexes after admission predict in-hospital mortality in patients with extensive burns[J].Burns,2024,50(4):980-990.DOI: 10.1016/j.burns.2024.01.020.
    [29]
    UrbanowiczT, MichalakM, Olasińska-WiśniewskaA, et al. Neutrophil counts, neutrophil-to-lymphocyte ratio, and systemic inflammatory response index (SIRI) predict mortality after off-pump coronary artery bypass surgery[J]. Cells,2022,11(7):1124.DOI: 10.3390/cells11071124.
    [30]
    HuB,YangXR,XuY,et al.Systemic immune-inflammation index predicts prognosis of patients after curative resection for hepatocellular carcinoma[J].Clin Cancer Res,2014,20(23):6212-6222.DOI: 10.1158/1078-0432.CCR-14-0442.
    [31]
    QiQ,ZhuangL,ShenY,et al.A novel systemic inflammation response index (SIRI) for predicting the survival of patients with pancreatic cancer after chemotherapy[J].Cancer,2016,122(14):2158-2167.DOI: 10.1002/cncr.30057.
    [32]
    XiaY, XiaC, WuL, et al. Systemic immune inflammation index (SII), system inflammation response index (SIRI) and risk of all-cause and cardiovascular mortality: a 20-year follow-up cohort study of 42,875 US adults[J]. J Clin Med,2023,12(3):1128.DOI: 10.3390/jcm12031128.
    [33]
    JeschkeMG,MlcakRP,FinnertyCC,et al.Burn size determines the inflammatory and hypermetabolic response[J].Crit Care,2007,11(4):R90.DOI: 10.1186/cc6102.
    [34]
    GabayC,KushnerI.Acute-phase proteins and other systemic responses to inflammation[J].N Engl J Med,1999,340(6):448-454.DOI: 10.1056/NEJM199902113400607.
    [35]
    FinnertyCC,HerndonDN,PrzkoraR,et al.Cytokine expression profile over time in severely burned pediatric patients[J].Shock,2006,26(1):13-19.DOI: 10.1097/01.shk.0000223120.26394.7d.
    [36]
    XiaoW,MindrinosMN,SeokJ,et al.A genomic storm in critically injured humans[J].J Exp Med,2011,208(13):2581-2590.DOI: 10.1084/jem.20111354.
    [37]
    MartiniWZ,WolfSE,ChinkesDL,et al.Enhanced albumin synthesis in severely burned adults[J].Shock,2010,34(4):364-368.DOI: 10.1097/SHK.0b013e3181d8844b.
    [38]
    CartottoR, CallumJ. A review on the use of plasma during acute burn resuscitation[J]. J Burn Care Res,2020,41(2):433-440.DOI: 10.1093/jbcr/irz184.
    [39]
    SaffleJI.The phenomenon of "fluid creep" in acute burn resuscitation[J].J Burn Care Res,2007,28(3):382-395.DOI: 10.1097/BCR.0B013E318053D3A1.
    [40]
    XuZ, ZhangK, LiuD, et al. Predicting mortality and risk factors of sepsis related ARDS using machine learning models[J]. Sci Rep,2025,15(1):13509.DOI: 10.1038/s41598-025-96501-w.
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