Readily Accessible Serum Biomarkers as Potential Indicators of Radiation Combined Burn Injury

Introduction: Radiation combined burn injury (RCBI) results in markedly greater morbidity and mortality than either insult alone, yet its early recognition remains challenging, particularly in mass-casualty events. Serum is easily accessible, and its routine biomarker alteration may aid clinicians in early decision-making. Objective: To determine whether routine serum biochemical markers can serve as a reliable indicator for early detection, severity assessment, and risk stratification of radiation combined burn injury. Materials and Methods: In this study, a murine model of combined radiation and burn injury (4 Gy + 80°C burn) was used to evaluate serum biochemical alterations over 28 days following burn injury only, radiation injury only, and radiation combined with burn injury only groups. Assays included aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), De Ritis ratio (AST/ALT), cholesterol, triglycerides, inorganic phosphate, iron, and albumin. Results: Combined injury produces a distinct and time-dependent biochemical alteration, characterized by an early elevation in AST and ALT levels, a brief increase in triglycerides after one week, and a delayed rise in alkaline phosphatase levels. Elevations in albumin and iron levels, and a delayed decrease in inorganic phosphate, are more pronounced and persistent in combined injury than in either single insult alone. Conclusion: These routine serum biomarkers can serve as accessible and clinically relevant indicators for early detection of radiation-combined burn injury and risk stratification for affected patients. Their collective interpretation could support decisions on early therapeutics and casualty management. Overall, the study addresses a critical challenge in mass-casualty and resource-limited settings by evaluating easily accessible diagnostic biomarkers.