Pre-Grafting Infection Biomarker Burden and Autologous Skin Graft Take in Adults with Severe Burns: A Single-Center Retrospective Cohort Study

Autologous split-thickness skin grafting is a principal method of definitive wound closure in patients with severe burns, but graft take may be compromised by systemic inflammation, local microbial burden, and wound-bed instability. This retrospective cohort study evaluated whether a composite pre-grafting infection biomarker burden score was associated with graft take after definitive autologous grafting. Adult patients with severe or extremely severe burns treated at Ganzhou People’s Hospital between January 1, 2022, and December 31, 2025, were screened. The score assigned one point each for C-reactive protein ≥150 mg/L, procalcitonin ≥1.5 ng/mL, endotoxin ≥0.25 EU/mL, fungal β-D-glucan ≥100 pg/mL, and a positive pre-grafting wound culture. The primary outcome was graft take rate at the first formal assessment within postoperative days 5–10, using postoperative day 7 when available. Among 84 included patients, the mean age was 46.2 ± 15.3 years, mean total body surface area burned was 50.6% ± 10.5%, and mean graft take rate was 87.5% ± 9.5%. Thirty-four patients achieved graft take ≥90%. Mean graft take declined from 92.5% ± 6.0% in patients with scores of 0–1 to 75.7% ± 11.8% in those with scores of 4–5. After adjustment for prespecified clinical covariates, each one-point increase in the score was associated with a 3.84-percentage-point decrease in graft take rate. Higher pre-grafting infection biomarker burden was therefore associated with poorer graft take and may support structured perioperative risk assessment in adults with severe burns.