Abstract
Shock-induced endothelial dysfunction plays a critical role in burn pathophysiology, with endothelial glycocalyx layer degradation promoting systemic inflammation, vascular instability, and multi-organ failure. The angiopoietin-tunica interna endothelial cell kinase (TIE2) axis, particularly the angiopoietin-1 (Ang-1) and angiopoietin-2 (Ang-2) balance, regulates endothelial function; elevated Ang-2 and a high Ang-2/1 ratio are linked to worse outcomes in critical illness. While well-documented in sepsis and trauma, effects of burn-induced angiopoietin dysregulation remain unclear. This study evaluates Ang-1, Ang-2, and the Ang-2/1 ratio as biomarkers of endothelial dysfunction and predictors of 30-day mortality in patients with burn injuries. In this prospective study, 62 adult patients with burn injuries were enrolled (January 2021-November 2024), with serum Ang-1 and Ang-2 measured via enzyme-linked immunosorbent assay on postburn day 1. Of 62 patients, 52 were analyzed; 78.05% of survivors and 90.91% of non-survivors were male. Median age was 45 (survivors) vs 54 years (non-survivors, P = .139). Non-survivors trended toward burns > 20% TBSA (72.73% vs 41.46%, P = .093). Ang-1 was lower in non-survivors (3.96 vs 7.97 ng/mL, P < .001), predicting early mortality (area under the receiver operating characteristic [AUROC]: 0.82) with a cut-off of 4.825 ng/mL and decreased mortality risk (odds ratio [OR]: 0.63, 95% confidence interval [CI]: 0.40-0.87, P = .017). Ang-2 was higher (6.07 vs 1.99 ng/mL, P < .001; AUROC: 0.95), with a cut-off of 3.554 ng/mL. The Ang-2/1 ratio was elevated (1.59 vs 0.23, P < .001; AUROC: 0.93), with a cut-off of 0.504 and increased mortality risk (OR: 2.17, 95% CI: 1.10-5.12, P = .038). Early Ang-1, Ang-2, and Ang-2/1 ratio levels correlate with 30-day mortality and may guide early prognostication.