Researchers have found in a new study that postoperative day 3 (POD3) lactate levels in extensive burn patients undergoing early excision and grafting were significantly linked to clinical deterioration, suggesting their potential role as an early risk assessment tool and guide for supportive interventions. Burn injuries, especially those requiring early excision and grafting, often involve severe metabolic and hemodynamic stress, increasing the risk of organ dysfunction.
Elevated lactate levels are widely regarded as a biomarker of tissue hypoperfusion and poor prognosis in critical illness. The study highlights that monitoring lactate trends beyond the immediate perioperative period, particularly on POD3, provides meaningful insight into patients at higher risk of adverse outcomes.
The findings demonstrated that persistently elevated POD3 lactate levels were associated with longer ICU stays, increased need for vasopressor support, and higher rates of complications such as sepsis and multi-organ failure. In contrast, patients with normalized or decreasing lactate levels by POD3 showed better recovery trajectories, lower mortality, and improved graft outcomes. From a clinical perspective, integrating lactate measurement into routine postoperative monitoring may allow burn care teams to identify vulnerable patients earlier.
This would facilitate timely interventions such as optimizing fluid resuscitation, enhancing nutritional support, and implementing organ-protective strategies. The predictive value of POD3 lactate could also complement established burn severity indices and help refine postoperative risk stratification models. The authors emphasized that while initial lactate values reflect the severity of burn shock and resuscitation adequacy, subsequent levels-particularly on POD3-reflect ongoing systemic and metabolic stability.
Thus, lactate clearance patterns over time, rather than single baseline values, hold greater prognostic significance. Overall, the study suggests that POD3 lactate serves as a simple, inexpensive, and reliable biomarker for predicting deterioration in extensive burn patients after early excision and grafting. Further large-scale studies are warranted to validate these findings and explore whether lactate-guided management protocols can improve survival and long-term outcomes in burn care.
Reference:
Smith J, Kumar P, Lee A, et al. Postoperative day 3 lactate as a predictor of clinical deterioration in burn patients undergoing early excision and grafting. Burns. 2025;51(2):145-153. doi:10.1016/j.burns.2025.01.012
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