Clinical characteristics, treatment strategies, and amputation outcomes in electrical burn patients: A single-center experience

Abstract

Objective Electrical burns are associated with deep tissue damage and a high risk of limb loss. Early identification of patients at risk for amputation remains challenging, as traditional predictors such as voltage level and total body surface area (TBSA) may not adequately reflect tissue injury. This study aimed to evaluate clinical, laboratory, and treatment-related factors associated with amputation in adult patients with electrical burns, with a focus on biomarker-based risk prediction. Material and Methods This single-center retrospective cohort study included adult patients hospitalized for electrical burns between February 2019 and October 2025. Patients with incomplete records or hospital stays <7 days were excluded. Demographic data, burn characteristics, electrocardiographic findings, surgical interventions, and laboratory parameters at admission and day 7 were recorded. Univariate and multivariate logistic regression analyses were performed to identify factors associated with amputation. Discriminative ability was assessed using receiver operating characteristic (ROC) curve analysis. Results A total of 83 patients were included (91.6% male; median age 32 years), with 75.9% exposed to high voltage. Amputation was required in 22.9%, and mortality was 2.4%. Compared with patients who did not undergo amputation, those requiring amputation had significantly higher admission levels of creatine kinase (CK), CK-MB, aspartate aminotransferase, alanine aminotransferase (ALT), lactate dehydrogenase (LDH), C-reactive protein, neutrophils, and neutrophil/lymphocyte ratio, whereas albumin, lymphocyte count, and HALP score were significantly lower. No significant differences were observed between the amputation and non-amputation groups with respect to voltage level or TBSA. In multivariable analysis, none of the evaluated variables remained independently associated with amputation; however, LDH (odds ratio=1.001, p=0.074) and HALP score (odds ratio=0.683, p=0.056) showed borderline associations. ROC analysis showed good performance for HALP, ALT, and LDH (area under the curve: 0.76-0.77). Conclusion Amputation risk in electrical burns is more closely related to biomarkers of muscle injury and inflammation than to voltage or TBSA. Although no independent predictors were identified in multivariable analysis, admission LDH and HALP score showed borderline associations with amputation risk, and several laboratory biomarkers demonstrated meaningful discriminatory performance. Early laboratory assessment may therefore contribute to risk stratification and support limb-preserving strategies. Prospective multicenter studies are needed for validation.