Transfusion requirements as a surrogate marker of mortality and morbidity in adults with severe burns: A retrospective cohort study.

Objective: Although blood transfusion is necessary for addressing anemia, coagulopathy, and systemic inflammation, transfusions also carry risks that may influence morbidity and mortality. This study, of patients with burns treated at a tertiary care centre, was conducted from October 2024 to May 2025. It aimed to investigate the association between blood and blood product transfusion requirements and clinical outcomes in adult patients with severe burns. Additionally, the study identified other predictors of mortality, and examined the prognostic role of common biochemical markers and complications in determining patient outcomes. Material and Methods: This retrospective cohort study analyzed 82 eligible adult patients with burns. Patients were considered eligible if they were 18 years of age or older, were admitted for acute burn injury and had complete clinical and laboratory data. Demographic, clinical, laboratory, and transfusion data were retrieved from electronic medical records. Cox proportional hazards regression was used to identify independent predictors of mortality, while Kaplan-Meier analysis assessed survival trends. Results: Participants were grouped into survivors (n=33) and non-survivors (n=49). Non-survivors required higher total volume of red blood cells (11 vs. 6 units), fresh frozen plasma (11 vs. 5 units), and platelets (4 vs. 0 units), particularly in the intensive care unit (ICU) setting. Compared to survivors, non-survivors also had elevated creatinine levels, lower platelet counts, and higher rates of complications such as pneumonia and dialysis. Cox regression confirmed total body surface area burned as the strongest independent predictor of mortality. Conclusion: High transfusion requirements in the ICU are associated with increased mortality in patients with severe burns and may serve as a surrogate marker for disease severity. These findings support the need for restrictive, individualized transfusion strategies and underscore the importance of integrating transfusion parameters into early risk assessment and prognostic models in burn care.