Hypoalbuminemia during the first 24 hours is not an independent risk factor for mortality in major burns

Major burn injuries commonly present with hypoalbuminemia within the first 24 hours. This study aimed to determine whether early hypoalbuminemia independently predicts mortality in severe burns. This single-center, retrospective cohort study included patients aged 14 years and older with burns covering at least 20% of their body surface area, admitted between January 2006 and December 2023 in a university teaching hospital. Exclusion criteria were admission more than 8 hours post-injury or transfer to another unit within the first week. Albumin levels within the first 24 hours were recorded. The primary outcome was 28-day mortality. 161 patients were included with a median burn area of 38% (IQR 25-65) and an Abbreviated Burn Severity Index score of 9 (IQR 7-11.5). Mortality was 33% (53/161). While univariate analysis showed that lower albumin was associated with increased mortality (OR 0.91, 95% CI 0.86–0.96, p=0.001), this association was not significant after adjustment for burn severity (OR 0.99, 95% CI 0.93–1.06, p=0.87). The predictive value of minimum serum albumin for mortality was low with an area under the curve of 0.68. The optimal albumin threshold for predicting mortality was 24 g/L (sensitivity 81.0%, specificity 49.5%). Albumin levels below this threshold were not significantly associated with higher mortality in a time-to-event analysis (HR 1.72, 95% CI 0.79–3.73, p=0.169). Hypoalbuminemia in the first 24 hours was not found to be an independent risk factor for 28-day mortality in this cohort, suggesting it as a marker of burn severity rather than an independent predictor.