The Creatinine-to-Protein Ratio Predicts All-Cause In-Hospital Mortality After Major Burns

Serum creatinine and protein levels have been proposed as potential biomarkers for predicting adverse outcomes in burn patients. This study aimed to investigate the prognostic utility of these markers and the serum creatinine-to-protein ratio in relation to in-hospital mortality following severe burn injuries. This retrospective cohort study included burn patients admitted within a 13-year period, with a total body surface area (TBSA) affected of ≥20%. Creatinine, serum protein levels, and the creatinine-to-protein ratio were assessed on post-burn days (PBD) 1, 3, and 7. Multivariate analysis identified independent mortality predictors, and receiver operating characteristic (ROC) curves assessed predictive accuracy. Among 283 patients, an overall mortality rate of 24.7% was noted. Neither creatinine nor protein levels independently predicted mortality. However, the creatinine-to-protein ratio was significantly elevated in non-survivors on all measured days, with the PBD 7 value emerging as an independent predictor of in-hospital mortality. Ratios measured on PBD 3 and 7 yielded an area under the ROC curve of 0.75, indicating robust predictive capability. The post-burn creatinine-to-protein ratio, particularly on PBD 7, is a reliable, accessible, and cost-effective biomarker for mortality risk in severe burn patients. Its use could enhance early prognostic evaluation in burn care.