Decoding burn trauma: biomarkers for early diagnosis of burn-induced pathologies

Abstract

Burn injuries represent a significant global challenge due to their multifaceted nature, characterized by a complex cascade of metabolic and immune dysfunction that can result in severe complications. If not identified and managed promptly, these complications can escalate, often leading to fatal outcomes. This underscores the critical importance of timely and precise diagnosis. Fortunately, biomarkers for burn-induced pathologies and outcomes have emerged as powerful diagnostic and prognostic tools. These biomarkers enable early diagnosis and intervention, facilitate risk assessment, support patient-specific treatment, monitoring of disease progression, and therapeutic efficacy, ultimately contributing to improved patient outcomes. However, while previous studies have provided valuable biomarkers for the detection of burn-induced pathologies, many of these were constrained by the techniques and sample sizes available at the time, which can limit the generalizability of the findings. This review highlights numerous biomarkers studied in the literature to date, underscoring the need to replicate these findings in more diverse and representative populations. It also emphasizes the importance of advancing research efforts to develop more efficient, accurate, and cost-effective approaches for integrating biomarkers into clinical practice.

Keywords: Biomarkers; Burns; Complications; Hypermetabolism; Immunopathy; Inflammation; Multiorgan damage; Sepsis; Thermal injury.

Fig. 1

Changes in Levels of Biomarkers that Indicate Severity, Poor Outcomes, and Risk of Mortality in Burn Patients. A summary of the changes in levels of biomarkers that signify severity, poor outcomes, and risk of mortality post-burn, including immunopathy, complementopathy, and metabolic dysfunction. DAMPs, Damage-associated molecular pattern; PAMPs, Pathogen-associated molecular pattern; CRP, C-reactive protein; WBC, White blood cell; VEGF, Vascular endothelial growth factor; NLR, Neutrophil-lymphocyte ratio; C1-INH, C1 inhibitor; FFAs, free fatty acids; 3-MTH, 3-Methylhisidine; IL-6, interleukin-6. Created in BioRender. Jeschke, M. (2024) https://BioRender.com/j50s293

Fig. 2

Overview of Biomarker Alterations in Post-burn Pathophysiological Conditions and Complications. A summary of the changes in levels of biomarkers as a result of post-burn pathophysiological conditions and complications, including coagulopathy, sepsis, endotheliopathy, and multiple organ failure. CRP, C-reactive protein; PCT, Procalcitonin; sTM, Soluble thrombomodulin; TFPI, Tissue factor pathway inhibitor; Ang-1, Angiopoietin-1; Ang-2, Angiopoietin-2; IL-6, interleukin-6; TNF-⍺, tumor necrosis factor-⍺; GSH, Glutathione; AAPR, Albumin-to-alkaline phosphatase ratio, GLDH, Glutamate dehydrogenase; TBIL, Total bilirubin; CK-MB, Creatine kinase-MB; NGAL, Neutrophil gelatinase associated lipocalin; KIM-1, Kidney injury molecule-1; sCR, Serum creatinine. Created in BioRender. Jeschke, M. (2024) https://BioRender.com/j50s293