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

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 multi-institutional 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 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-to-debridement, both strong drivers of CRP and ESR, were similarly absent.5 Their omission limits adjustment and may inflate biomarker effect estimates. 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.7 Statistical modeling: Only univariate ROC curves were provided. A multivariable logistic regression incorporating biomarker trajectories alongside age, TBSA, inhalation injury, and comorbidities would identify independent predictors and permit the development of a nomogram.8 Clinical integration: The authors suggest a multiparametric score but do not test one. External validation of a dynamic biomarker-augmented Revised Baux model could determine whether routine CRP or ESR measurements materially improve net reclassification.9 In summary, Khalili et al. reiterate the prognostic relevance of metabolic acidosis and inflammation after massive burns. Prospective, adequately powered studies that couple dynamic biomarker trends with robust multivariable adjustment are needed before LA, BD, ESR, or CRP can be endorsed as stand-alone triggers for escalation of care. Zeinab Mohseni Afshar: Investigation; writing—original draft. Mohammad Barary: Investigation; writing—original draft; writing—review and editing. Arefeh Babazadeh: Investigation; writing—original draft. Farhad Bagherian: Investigation; writing—original draft. Soheil Ebrahimpour: Investigation; writing—original draft; supervision. The authors thank the Infectious Diseases and Tropical Medicine Research Center of Babol University of Medical Sciences. The authors declare no conflicts of interest. The authors have nothing to report. The authors have nothing to report. The peer review history for this article is available at https://www.webofscience.com/api/gateway/wos/peer-review/10.1002/hkj2.70036. The authors have nothing to report.