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Article Navigation >  CHINESE JOURNAL OF BURNS AND WOUNDS  >  > Accepted Manuscript
Lou Jiaqi,Li Jiliang,Cui Shengyong,et al.A prospective study on the dynamic changes of inflammatory and immune indicators after injury and their predictive value for 21-day mortality risk in patients with severe burns[J].Chin J Burns Wounds,2026,42(11):1-10.DOI: 10.3760/cma.j.cn501225-20251121-00482.
Citation: Lou Jiaqi,Li Jiliang,Cui Shengyong,et al.A prospective study on the dynamic changes of inflammatory and immune indicators after injury and their predictive value for 21-day mortality risk in patients with severe burns[J].Chin J Burns Wounds,2026,42(11):1-10.DOI: 10.3760/cma.j.cn501225-20251121-00482.
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A prospective study on the dynamic changes of inflammatory and immune indicators after injury and their predictive value for 21-day mortality risk in patients with severe burns

doi: 10.3760/cma.j.cn501225-20251121-00482

  • Burn Department, Ningbo No.2 Hospital,Ningbo 315000, China

Funds:

Zhejiang Clinovation Pride CXTD202502004

Medical Scientific Reasearch Foundation of Zhejiang Province 2021KY1004, 2022KY1134, 2023RC081, 2025KY1395

2024 General Scientific Research Project of Zhejiang Provincial Department of Education Y202456684

Ningbo Top Medical and Health Research Program 2023030615

Project of NINGBO Leading Medical & Health Discipline 2022-F17

More Information
  • Corresponding author: Fan Youfen, Email: 13906683613@163.com
  • Received Date: 2025-11-21
    Available Online: 2026-11-02
    Abstract
  •   Objective  To investigate the dynamic changes of post-burn inflammatory and immune indicators in patients with severe burns and their predictive value for 21-day mortality risk.  Methods  This was a prospective cohort study. From January 2018 to December 2024, 760 patients with severe burns who met the inclusion criteria were admitted to the Department of Burns of Ningbo No. 2 Hospital. Based on the outcomes at 21 days post-burn, the patients were divided into death group (139 cases, 106 males and 33 females, aged 18-78 years) and survival group (621 cases, 467 males and 154 females, aged 18-78 years). Clinical data of patients in the two groups (such as sex, age, and burn index) were collected, and IL-6 and CD4+/CD8+ ratio were monitored on days 1, 3, 7, 14, and 21 post-burn. Meanwhile, the differences between IL-6 and CD4+/CD8+ ratio on day 7 post-burn and the corresponding values on day 1 post-burn were calculated, namely ΔIL-6 and Δ(CD4+/CD8+) ratio. The longitudinal trajectories of IL-6 and CD4+/CD8+ ratio post-burn were analyzed (n=760). A baseline Cox proportional hazards regression model (hereinafter referred to as the Cox model) was constructed to analyze the independent associations of age, sex, burn index, and IL-6 and CD4+/CD8+ ratio on day 1 post-burn with 21-day mortality risk (n=753). A dynamic Cox model was constructed to analyze the independent associations of age, sex, burn index and Δ(CD4+/CD8+) ratio with 21-day mortality risk (n=746). Receiver operating characteristic (ROC) curves were used to evaluate the predictive value of IL-6 level on day 7 post-burn, ΔIL-6, Δ(CD4+/CD8+) ratio, and burn index for 21-day mortality risk, and the optimal cut-off value of Δ(CD4+/CD8++) ratio was recorded. According to whether the Δ(CD4+/CD8+) ratio was higher than the cut-off value, patients were divided into increased group (363 males and 118 females, aged 18-78 years) and decreased group (207 males and 68 females, aged 18-78 years), and Kaplan-Meier survival curves were plotted for the two groups and compared. Time-dependent ROC analysis was used to compare the predictive abilities of the Cox models constructed based on IL-6 on day 7 post-burn, ΔIL-6, and Δ(CD4+/CD8+) ratio (with sample sizes of 760, 746, and 746, respectively), as well as the baseline Cox model and the dynamic Cox model, for mortality risk at 7, 14, and 20 days post-burn.  Results  Patients' IL-6 levels exhibited a downward trend over time post-burn (with an estimate of -4.52, a standard error of 0.10, t=-45.61, P<0.05), and IL-6 levels in death group were higher than those in survival group (with an estimate of 35.64, a standard error of 4.86, t=7.33, P<0.05); the longitudinal trajectories of IL-6 levels between survival group and death group were significantly different (with an estimate of -0.879, a standard error of 0.23, t=-3.78, P<0.05). Patients' CD4+/CD8+ ratio exhibited an upward trend over time post-burn (with an estimate of 0.02, a standard error of <0.01, t=21.48, P<0.05), and the CD4+/CD8+ ratio in death group was lower than that in survival group (with an estimate of -0.11, a standard error of 0.03, t=-4.04, P<0.05); the longitudinal trajectories of CD4+/CD8+ ratio between the two groups were significantly different (with an estimate of <0.01, a standard error of <0.01, t=3.64, P<0.05). The baseline Cox model showed that burn index was an independent predictor of 21-day mortality risk (P<0.05), while IL-6 and CD4+/CD8+ ratio on day 1 post-burn were potential independent predictors of 21-day mortality risk (with P values of 0.053 and 0.070, respectively). The dynamic Cox model showed that burn index was an independent predictor of 21-day mortality risk (P<0.05), while Δ(CD4+/CD8+) ratio was a potential independent predictor of 21-day mortality risk (P=0.058). The AUCs of IL-6 on day 7 post-burn, Δ(CD4+/CD8+) ratio, ΔIL-6, and burn index for predicting 21-day mortality risk were 0.66 (with a 95%CI of 0.61-0.70), 0.58 (with a 95%CI of 0.54-0.63), 0.55 (with a 95%CI of 0.50-0.61), and 0.62 (with a 95%CI of 0.57-0.68), respectively. The optimal cut-off value of Δ(CD4+/CD8+) ratio was -0.623. The 21-day survival rate of patients in increased group was lower than that in decreased group (χ²=26.20, P<0.05). The AUCs of the IL-6 Cox model on day 7 post-burn at 7, 14, and 20 days post-burn were 71.71% (with a 95%CI of 66.03%-77.39%), 61.38% (with a 95%CI of 55.42%-67.33%), and 61.38% (with a 95%CI of 55.42%-67.33%), respectively, all higher than those of the ΔIL-6 Cox model (59.38% (with a 95%CI of 50.62%-68.14%), 56.70% (with a 95%CI of 50.01%-63.38%), and 56.70% (with a 95%CI of 50.01%-63.38%)), the Δ(CD4+/CD8+) ratio Cox model (64.92% (with a 95%CI of 57.53%-72.31%), 57.19% (with a 95%CI of 50.65%-63.72%), and 57.19% (with a 95%CI of 50.65%-63.72%)), the baseline Cox model (70.02% (with a 95%CI of 63.39%-76.66%), 59.71% (with a 95%CI of 53.43%-66.00%), and 59.71% (with a 95%CI of 53.43%-66.00%)), and the dynamic Cox model (65.51% (with a 95%CI of 58.19%-72.83%), 57.12% (with a 95%CI of 50.58%-63.66%), and 57.12% (with a 95%CI of 50.58%-63.66%)).  Conclusions  In patients with severe burns, IL-6 and CD4+/CD8+ ratio exhibit dynamic changes post-burn; patients in the death group have stronger early inflammatory responses and more severe immunosuppression. IL-6 level on day 7 post-burn has certain predictive value for 21-day mortality.

     

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