Multi-Organ Failure in Adult Patients Admitted to Intensive Care with Severe Burns—A Retrospective Cohort Study

Introduction: Multi-organ failure (MOF) is the predominant cause of death in patients with burns who survive their initial injury. MOF can be “sterile” in nature (driven by the burn injury) or related to sepsis. The time course and predictors of MOF in major burns have not been well characterised. Methods: This is a retrospective cohort study of all adult patients with total body surface area (TBSA) burns > 15% admitted to the ICU of a UK tertiary burn centre between 2016 and 2025. Sequential Organ Failure Assessment (SOFA), DENVER2, and American Burn Association Sepsis Criteria were calculated on days 1, 3, 5, 7, 10, 14, 17, and 21 of ICU admission. Logistic regression models were used to explore variables associated with MOF. Results: In total, 131 patients were included. Patients who developed MOF were older, with more severe burns and inhalational injury. MOF incidence peaked at day 5 and then declined, while sepsis peaked at day 10. Renal failure and renal replacement therapy were uncommon, but both were strongly associated with reduced survival. Risk factors for early MOF were mainly related to burn severity, whereas sepsis was the predominant risk factor for late MOF. Shock severity on admission and more aggressive fluid resuscitation were also associated with MOF. Conclusions: Early organ dysfunction appears driven by the burn injury and associated shock, whereas later dysfunction is sepsis-driven. Renal failure is the organ failure most associated with mortality.