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Commentary on “Comparing predictor value of lactic acid, base deficit, erythrocyte sedimentation rate, and C‐reactive protein in severe burn outcome”

Year: 2025

Type: editorial

Abstract: Commentary on "Comparing predictor value of lactic acid, base deficit, erythrocyte sedimentation rate, and Creactive protein in severe burn outcome" Dear Editor, Khalili et al. evaluated lactic acid (LA), base deficit (BD), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) as mortality predictors in adults with ≥25% total body surface area burns. 1 Although their work underscores the importance of rapid risk stratification, several methodological limitations temper the conclusions.1. Study design and population: The single-center retrospective design (139 patients over 3 years) is vulnerable to a selection bias and lacks ethnic and practice variability.Validation in prospective multiinstitutional cohorts is essential.2 Moreover, established composite scores, such as Revised Baux and FLAMES, were not calculated, leaving unanswered whether LA or BD provides an incremental prognostic value over traditional models.3 2. Unmeasured and uncontrolled confounders: Key modifiers of lactate kinetics and systemic inflammation, including chronic cardiovascular, renal, hepatic disease, diabetes, smoking, and alcohol use, were not collected.4,5 Infection status and time-todebridement, both strong drivers of CRP and ESR, were similarly absent.5 Their omission limits adjustment and may inflate biomarker effect estimates.3. Biomarker handling and reporting: Static measurements on days 1, 3, and 7 were analyzed, yet lactate clearance (>10% reduction within 24 h) outperforms absolute lactate in trauma and burn populations.6 Serial trends of BD and CRP could yield higher discrimination while mitigating multicollinearity.Table 2 describes higher BD in nonsurvivors, although BD values are more negative; clarification of the sign convention and units is warranted.ROC results list "1-specificity" without directly reporting specificity or confidence intervals; following STARD 2015 would enhance transparency.

Source: Hong Kong Journal of Emergency Medicine

DOI: 10.1002/hkj2.70036

Authors: Zeinab Mohseni Afshar, Mohammad Barary, Arefeh Babazadeh, Farhad Bagherian, Soheil Ebrahimpour

Institutions: Babol University of Medical Sciences, Shahid Beheshti University, Shahid Beheshti University of Medical Sciences

Language: English

Topic: Burn Injury Management and Outcomes

Subfield: Epidemiology

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $1,800