The effect of blood urea nitrogen (BUN)/albumin ratio in evaluating mortality in pediatric burn patients with 20% or greater total body surface area involvement.

BACKGROUND

This study aims to evaluate the predictive value of the blood urea nitrogen (BUN)/albumin ratio for in-hospital mortality in pediatric burn patients with a total body surface area (TBSA) of 20% or greater and to compare its performance with established scoring systems, namely the Abbreviated Burn Severity Index (ABSI) and the Pediatric Baux Score (P-Baux).

METHODS

Patients hospitalized with burns involving 20% or greater TBSA in our pediatric burn unit between 2018 and 2023 were reviewed retrospectively. Patients were analyzed for demographic information, basic clinical data, cause of burn, operative interventions, ABSI and P-Baux scores and the follow-up period. The BUN/albumin ratio was calculated using BUN and albumin values measured at the time of index hospital admission. Data were evaluated for in-hospital mortality.

RESULTS

A total of 212 patients were included in the study. Patients were divided into two groups: survivors and non-survivors. The non-survivor group had significantly higher TBSA involvement, full-thickness burns, inhalation injuries, and operative requirements (p<0.001). The overall mortality rate was 4.5%. Receiver operating characteristic (ROC) analysis demonstrated that the BUN/albumin ratio is a strong predictor of in-hospital mortality, with predictive power similar to that of the ABSI and P-Baux scores. The cut-off value for mortality prediction using the BUN/albumin ratio was >5.24.

CONCLUSION

The BUN/albumin ratio is a simple and easily accessible marker that demonstrates strong statistical value in predicting in-hospital mortality in pediatric patients with burns covering 20% or more of the body. Given its availability from routine blood tests, we believe it may serve as a practical and helpful tool for clinicians caring for pediatric burn patients.