Predictive value of acute liver failure for sepsis-free survival in burn patients
10.3760/cma.j.issn.1671-0282.2025.05.007
- VernacularTitle:评估急性肝衰竭对烧伤患者无脓毒症生存的预测价值
- Author:
Xinran DING
1
;
Wei ZHANG
;
Yifan LIU
;
Dayuan XU
;
Xirui TONG
;
Yuntao YAO
;
Runzhi HUANG
;
Shizhao JI
;
Zhaofan XIA
Author Information
1. 海军军医大学附属第一人民医院烧伤外科，全军烧伤研究所，上海 200433
- Keywords:
Burn;
Acute liver failure;
Sepsis;
Organ crosstalk;
Invasive procedures;
Prognosis;
Multiple organ dysfunction syndrome
- From:
Chinese Journal of Emergency Medicine
2025;34(5):648-655
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To assess the predictive value of acute liver failure (ALF) for sepsis-free survival (SFS) in burn patients and to identify associated risk factors.Methods:A retrospective cohort study was conducted on burn patients meeting inclusion criteria from the 2014 Kunshan aluminum dust explosion disaster (August 2, 2014 - April 13, 2015). Eligible patients were stratified into ALF and non-ALF groups based on the development of ALF. Demographic characteristics, total burn surface area, organ dysfunction, time to sepsis onset, and clinical outcomes were collected and compared between groups. Kaplan-Meier survival analysis and multivariate Cox regression were performed to assess the impact of ALF on SFS. A nomogram model was constructed for individualized risk prediction.Results:Among 185 enrolled patients (ALF group:21, non-ALF group:164), ALF incidence was 11.35%. The ALF group demonstrated higher mortality (85.71% vs. 34.15%, P<0.001) and SFS failure rates (100.00% vs. 61.59%, P<0.001) compared to non-ALF patients. Multivariate Cox analysis identified ALF as an independent sepsis predictor ( HR=1.68, 95% CI: 1.00-2.80, P<0.05). Time-dependent ROC analysis showed AUCs of 0.626, 0.714, 0.703, and 0.706 for SFS prediction at 2, 4, 8, and 12 weeks respectively. The nomogram model demonstrated that ALF combined with other parameters effectively predicted sepsis risk within 2-12 weeks post-injury. ALF development showed significant associations with concurrent organ dysfunction including acute kidney injury, acute heart failure, and acute respiratory distress syndrome (all P<0.001). A higher proportion of ALF patients received hemodialysis ( P<0.001) and pre-hospital central venous catheterization ( P=0.017). Conclusions:ALF independently predicts SFS failure and correlates strongly with poor prognosis in burn patients. Early ALF recognition and targeted interventions may facilitate sepsis risk stratification and precision prevention strategies.
