{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T15:16:59Z","timestamp":1783091819464,"version":"3.54.6"},"reference-count":57,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,8,18]],"date-time":"2025-08-18T00:00:00Z","timestamp":1755475200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cell. Infect. Microbiol."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Burn injuries are a common cause of trauma globally, with extensive burns (\u2265 50% total body surface area burned) associated with high rates of sepsis and mortality. This study aims to identify risk factors associated with sepsis and mortality in extensively burned patients and to develop accurate, interpretable predictive models via machine learning algorithms.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A retrospective cohort study was conducted utilizing data from two Burn Critical Care Units in Eastern China from 2012-2023. A total of 237 patients with extensive burns were included. We applied ten machine learning algorithms, including random forest, gradient boosting tree (GBT), and logistic regression, to predict sepsis and mortality. The models were evaluated via AUC, precision, recall, accuracy, and F1 score, and were compared with the SOFA score performance. Model interpretability was enhanced via SHapley Additive exPlanations (SHAP).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The key predictive factors for sepsis included the SOFA score, new onset shock, albumin, blood urea nitrogen (BUN), third-degree burned area, TBSA burned, white blood cell count, and inhalation injury. For mortality, the key predictive factors included alanine aminotransferase (ALT), the SOFA score, type of burn, new onset shock, third-degree burn area, TBSA burned, and sepsis. The RF model demonstrated superior performance in predicting sepsis (AUC = 0.977, accuracy = 0.945, recall = 0.964, precision = 0.930, and F1 score = 0.945). For mortality prediction, the GBT model yielded the highest AUC of 0.981 (accuracy = 0.952, recall = 0.965, precision = 0.942, and F1 score = 0.953). The sepsis prediction model outperformed the SOFA-based logistic regression model. Web-based calculators were developed to aid clinical decision-making.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Machine learning models, RF and GBT, demonstrate strong predictive ability for sepsis and mortality in extensive burn patients. The application of SHAP enhances model transparency, facilitating clinical interpretation and early intervention. Two web-based calculators can guide intensive care strategies and improve patient outcomes.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fcimb.2025.1586087","type":"journal-article","created":{"date-parts":[[2025,8,18]],"date-time":"2025-08-18T05:28:54Z","timestamp":1755494934000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["Development and validation of web-based, interpretable predictive models for sepsis and mortality in extensive burns"],"prefix":"10.3389","volume":"15","author":[{"given":"Shi-Qi","family":"Wang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kan","family":"Qiu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qi-Rui","family":"Zheng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bing-Jie","family":"Zhou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ming-Yu","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hai-Yan","family":"Zhong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yong","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Si-Ming","family":"Yuan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,8,18]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"940","DOI":"10.6061\/clinics\/2013(07)09","article-title":"Serum albumin level as a risk factor for mortality in burn patients","volume":"68","author":"Aguayo-Becerra","year":"2013","journal-title":"Clinics (Sao Paulo)"},{"key":"B2","doi-asserted-by":"publisher","first-page":"515","DOI":"10.1016\/0140-6736(93)90277-n","article-title":"High serum procalcitonin concentrations in patients with sepsis and infection","volume":"341","author":"Assicot","year":"1993","journal-title":"Lancet"},{"key":"B3","volume-title":"Contribution \u00e0 l\u2019\u00e9tude du traitement local des br\u00fblures thermiques \u00e9tendues","author":"Baux","year":"1961"},{"key":"B4","doi-asserted-by":"publisher","first-page":"311","DOI":"10.1016\/j.acra.2019.03.011","article-title":"A machine learning algorithm to estimate sarcopenia on abdominal CT","volume":"27","author":"Burns","year":"2020","journal-title":"Acad. Radiol."},{"key":"B5","doi-asserted-by":"publisher","first-page":"288","DOI":"10.1016\/j.burns.2017.08.015","article-title":"Platelet count: A predictor of sepsis and mortality in severe burns","volume":"44","author":"Cato","year":"2018","journal-title":"Burns"},{"key":"B6","doi-asserted-by":"publisher","first-page":"105","DOI":"10.3760\/cma.j.issn.1009-2587.2013.02.003","article-title":"Diagnosis and comprehensive management of sepsis after burn","volume":"29","author":"Chai","year":"2013","journal-title":"Zhonghua Shao Shang Za Zhi"},{"key":"B7","doi-asserted-by":"publisher","first-page":"321","DOI":"10.1613\/jair.953","article-title":"SMOTE: synthetic minority over-sampling technique","volume":"16","author":"Chawla","year":"2002","journal-title":"J. Artif. Intell. Res."},{"key":"B8","unstructured":"Cheng\n              W.\n            \n          \n          Beijing, China\n          Chinese People's Liberation Army (PLA) Medical School\n          The current status of epidemiological study of burns and a multicenter study on the epidemiology and prognosis of massively burned patients in China (Master's thesis)\n          \n          2017"},{"key":"B9","doi-asserted-by":"publisher","first-page":"207","DOI":"10.1016\/j.burns.2019.06.004","article-title":"Mortality in paediatric burns at the Women\u2019s and Children\u2019s Hospital (WCH), Adelaide, South Australia: 1960-2017","volume":"46","author":"Chong","year":"2020","journal-title":"Burns"},{"key":"B10","doi-asserted-by":"publisher","first-page":"837","DOI":"10.2307\/2531595","article-title":"Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach","volume":"44","author":"DeLong","year":"1988","journal-title":"Biometrics"},{"key":"B11","doi-asserted-by":"publisher","first-page":"1920","DOI":"10.1161\/circulationaha.115.001593","article-title":"Machine learning in medicine","volume":"132","author":"Deo","year":"2015","journal-title":"Circulation"},{"key":"B12","doi-asserted-by":"publisher","first-page":"654","DOI":"10.3760\/cma.j.cn501120-20200306-00129","article-title":"Systematic review of the epidemiological characteristics of inhalation injury in burn patients in China","volume":"37","author":"Dou","year":"2021","journal-title":"Zhonghua Shao Shang Za Zhi"},{"key":"B13","doi-asserted-by":"publisher","first-page":"205","DOI":"10.1016\/j.burns.2018.08.012","article-title":"Gender has no influence on mortality after burn injuries: A 20-year single center study with 839 patients","volume":"45","author":"Ederer","year":"2019","journal-title":"Burns"},{"key":"B14","doi-asserted-by":"publisher","first-page":"478","DOI":"10.1177\/1753425911422723","article-title":"Endotoxin{middle dot}albumin complexes transfer endotoxin monomers to MD-2 resulting in activation of TLR4","volume":"18","author":"Esparza","year":"2012","journal-title":"Innate Immun."},{"key":"B15","doi-asserted-by":"publisher","first-page":"781","DOI":"10.1016\/s0140-6736(85)91447-3","article-title":"Increased vascular permeability: a major cause of hypoalbuminaemia in disease and injury","volume":"1","author":"Fleck","year":"1985","journal-title":"Lancet"},{"key":"B16","doi-asserted-by":"publisher","first-page":"e406","DOI":"10.1016\/s2589-7500(22)00063-2","article-title":"AI recognition of patient race in medical imaging: a modelling study","volume":"4","author":"Gichoya","year":"2022","journal-title":"Lancet Digit Health"},{"key":"B17","doi-asserted-by":"publisher","first-page":"47818","DOI":"10.1074\/jbc.M206404200","article-title":"An essential role for albumin in the interaction of endotoxin with lipopolysaccharide-binding protein and sCD14 and resultant cell activation","volume":"277","author":"Gioannini","year":"2002","journal-title":"J. Biol. Chem."},{"key":"B18","doi-asserted-by":"publisher","first-page":"636","DOI":"10.1097\/TA.0b013e3181840c6d","article-title":"The FLAMES score accurately predicts mortality risk in burn patients","volume":"65","author":"Gomez","year":"2008","journal-title":"J. Trauma"},{"key":"B19","doi-asserted-by":"publisher","first-page":"23","DOI":"10.1186\/s41038-017-0089-5","article-title":"Sepsis in the burn patient: a different problem than sepsis in the general population","volume":"5","author":"Greenhalgh","year":"2017","journal-title":"Burns Trauma"},{"key":"B20","doi-asserted-by":"publisher","first-page":"776","DOI":"10.1097\/BCR.0b013e3181599bc9","article-title":"American Burn Association consensus conference to define sepsis and infection in burns","volume":"28","author":"Greenhalgh","year":"2007","journal-title":"J. Burn Care Res."},{"key":"B21","doi-asserted-by":"publisher","first-page":"770","DOI":"10.3760\/cma.j.issn.1009-2587.2018.11.010","article-title":"National experts consensus on clinical diagnosis and treatment of inhalation injury, (2018 version)","volume":"34","author":"Guo","year":"2018","journal-title":"Zhonghua Shao Shang Za Zhi"},{"key":"B22","doi-asserted-by":"publisher","first-page":"1263","DOI":"10.1109\/tkde.2008.239","article-title":"Learning from imbalanced data","volume":"21","author":"Haibo","year":"2009","journal-title":"IEEE Trans. Knowledge Data Eng."},{"key":"B23","doi-asserted-by":"publisher","first-page":"49","DOI":"10.1186\/s40779-022-00403-1","article-title":"Gastrointestinal dysfunction is associated with mortality in severe burn patients: a 10-year retrospective observational study from South China","volume":"9","author":"He","year":"2022","journal-title":"Mil Med. Res."},{"key":"B24","doi-asserted-by":"publisher","first-page":"786","DOI":"10.3760\/cma.j.cn501120-20200623-00323","article-title":"National experts consensus on prevention and treatment of burn shock, (2020 version)","volume":"36","author":"Hunag","year":"2020","journal-title":"Zhonghua Shao Shang Za Zhi"},{"key":"B25","doi-asserted-by":"publisher","first-page":"358","DOI":"10.1016\/j.burns.2012.07.011","article-title":"Epidemiology and outcome of burns: Early experience at the country\u2019s first national burns Centre","volume":"39","author":"Iqbal","year":"2013","journal-title":"Burns"},{"key":"B26","doi-asserted-by":"publisher","first-page":"1258","DOI":"10.1186\/s12879-021-06971-2","article-title":"Immature granulocyte percentage for prediction of sepsis in severe burn patients: a machine leaning-based approach","volume":"21","author":"Jeon","year":"2021","journal-title":"BMC Infect. Dis."},{"key":"B27","first-page":"137","article-title":"Can we use C-reactive protein levels to predict severe infection or sepsis in severely burned patients","volume":"3","author":"Jeschke","year":"2013","journal-title":"Int. J. Burns Trauma"},{"key":"B28","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1038\/s41572-020-0145-5","article-title":"Burn injury","volume":"6","author":"Jeschke","year":"2020","journal-title":"Nat. Rev. Dis. Primers"},{"key":"B29","doi-asserted-by":"publisher","first-page":"818","DOI":"10.1097\/00003246-198510000-00009","article-title":"APACHE II: a severity of disease classification system","volume":"13","author":"Knaus","year":"1985","journal-title":"Crit. Care Med."},{"key":"B30","doi-asserted-by":"publisher","first-page":"189","DOI":"10.1016\/j.burns.2006.07.001","article-title":"Inflammatory markers in patients with severe burn injury. What is the best indicator of sepsis","volume":"33","author":"Lavrentieva","year":"2007","journal-title":"Burns"},{"key":"B31","doi-asserted-by":"publisher","first-page":"159","DOI":"10.1016\/j.burns.2004.08.015","article-title":"A qualitative and quantitative analysis of protein loss in human burn wounds","volume":"31","author":"Lehnhardt","year":"2005","journal-title":"Burns"},{"key":"B32","doi-asserted-by":"publisher","first-page":"654","DOI":"10.1097\/sla.0000000000005198","article-title":"Biomarkers for the early diagnosis of sepsis in burns: systematic review and meta-analysis","volume":"275","author":"Li","year":"2022","journal-title":"Ann. Surg."},{"key":"B33","doi-asserted-by":"publisher","first-page":"958","DOI":"10.1016\/j.burns.2005.06.006","article-title":"A three decade analysis of factors affecting burn mortality in the elderly","volume":"31","author":"Lionelli","year":"2005","journal-title":"Burns"},{"key":"B34","doi-asserted-by":"publisher","first-page":"911","DOI":"10.1016\/j.amjsurg.2015.03.021","article-title":"The influence of sex on outcomes in trauma patients: a meta-analysis","volume":"210","author":"Liu","year":"2015","journal-title":"Am. J. Surg."},{"key":"B35","doi-asserted-by":"publisher","first-page":"2","DOI":"10.1038\/s41551-018-0304-0","article-title":"Explainable machine-learning predictions for the prevention of hypoxaemia during surgery","author":"Lundberg","year":"2018","journal-title":"Nat. Biomed. engineering."},{"key":"B36","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1097\/BCR.0b013e31826450b5","article-title":"Novel predictors of sepsis outperform the American Burn Association sepsis criteria in the burn intensive care unit patient","volume":"34","author":"Mann-Salinas","year":"2013","journal-title":"J. Burn Care Res."},{"key":"B37","doi-asserted-by":"publisher","DOI":"10.3760\/cma.j.issn.1009-2587.2018.11.E006","article-title":"National experts consensus on tracheotomy and intubation for burn patients, (2018 version)","volume":"34","author":"Ming","year":"2018","journal-title":"Zhonghua Shao Shang Za Zhi"},{"key":"B38","doi-asserted-by":"publisher","first-page":"e469","DOI":"10.1097\/bcr.0000000000000355","article-title":"Burns: pathophysiology of systemic complications and current management","volume":"38","author":"Nielson","year":"2017","journal-title":"J. Burn Care Res."},{"key":"B39","doi-asserted-by":"publisher","first-page":"290","DOI":"10.1001\/jama.2016.20328","article-title":"Prognostic accuracy of the SOFA score, SIRS criteria, and qSOFA score for in-hospital mortality among adults with suspected infection admitted to the intensive care unit","volume":"317","author":"Raith","year":"2017","journal-title":"JAMA"},{"key":"B40","doi-asserted-by":"publisher","first-page":"1230","DOI":"10.1007\/s12630-022-02282-5","article-title":"White blood cell count trajectory and mortality in septic shock: a historical cohort study","volume":"69","author":"Rimmer","year":"2022","journal-title":"Can. J. Anesth."},{"key":"B41","doi-asserted-by":"publisher","first-page":"702","DOI":"10.1016\/j.burns.2013.08.023","article-title":"Prognostic factors in electrical burns: a review of 101 patients","volume":"40","author":"Saracoglu","year":"2014","journal-title":"Burns"},{"key":"B42","doi-asserted-by":"publisher","DOI":"10.3390\/healthcare11172437","article-title":"Improvement of predictive scores in burn medicine through different machine learning approaches","volume":"11","author":"Schmidt","year":"2023","journal-title":"Healthcare (Basel)"},{"key":"B43","doi-asserted-by":"publisher","first-page":"801","DOI":"10.1001\/jama.2016.0287","article-title":"The third international consensus definitions for sepsis and septic shock (Sepsis-3)","volume":"315","author":"Singer","year":"2016","journal-title":"JAMA"},{"key":"B44","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1186\/s41038-018-0140-1","article-title":"Survival analysis and mortality predictors of hospitalized severe burn victims in a Malaysian burns intensive care unit","volume":"7","author":"Tan Chor Lip","year":"2019","journal-title":"Burns Trauma"},{"key":"B45","doi-asserted-by":"publisher","DOI":"10.1186\/2110-5820-3-4","article-title":"Specific antioxidant properties of human serum albumin","volume":"3","author":"Taverna","year":"2013","journal-title":"Ann. Intensive Care"},{"key":"B46","doi-asserted-by":"publisher","first-page":"777","DOI":"10.14744\/tjtes.2020.37862","article-title":"Factors affecting the mortality at patients with burns: Single centre results","volume":"26","author":"Temiz","year":"2020","journal-title":"Ulus Travma Acil Cerrahi Derg"},{"key":"B47","doi-asserted-by":"publisher","first-page":"675","DOI":"10.1016\/j.burns.2004.03.006","article-title":"Recovery from the hepatic acute phase response in the severely burned and the effects of long-term growth hormone treatment","volume":"30","author":"Thomas","year":"2004","journal-title":"Burns"},{"key":"B48","doi-asserted-by":"publisher","first-page":"260","DOI":"10.1016\/s0196-0644(82)80096-6","article-title":"The abbreviated burn severity index","volume":"11","author":"Tobiasen","year":"1982","journal-title":"Ann. Emerg. Med."},{"key":"B49","doi-asserted-by":"publisher","first-page":"20","DOI":"10.1089\/sur.2020.348","article-title":"Detection of infection and sepsis in burns","volume":"22","author":"Torres","year":"2021","journal-title":"Surg. Infections"},{"key":"B50","doi-asserted-by":"publisher","first-page":"12354","DOI":"10.1038\/s41598-020-69433-w","article-title":"Novel application of an automated-machine learning development tool for predicting burn sepsis: proof of concept","volume":"10","author":"Tran","year":"2020","journal-title":"Sci. Rep."},{"key":"B51","doi-asserted-by":"publisher","DOI":"10.3390\/medicina58081066","article-title":"Infections in burn patients: A retrospective view over seven years","volume":"58","author":"Tsolakidis","year":"2022","journal-title":"Medicina"},{"key":"B52","volume-title":"The Injury Chart Book: A Graphical Overview of the Global Burden of Injuries","year":"2002"},{"key":"B53","doi-asserted-by":"publisher","first-page":"1241","DOI":"10.1016\/j.surg.2018.05.053","article-title":"Sepsis criteria versus clinical diagnosis of sepsis in burn patients: A validation of current sepsis scores","volume":"164","author":"Yan","year":"2018","journal-title":"Surgery"},{"key":"B54","doi-asserted-by":"publisher","first-page":"1905","DOI":"10.2147\/jir.s404983","article-title":"Long-term effects of severe burns on the kidneys: research advances and potential therapeutic approaches","volume":"16","author":"Yang","year":"2023","journal-title":"J. Inflammation Res. Volume"},{"key":"B55","doi-asserted-by":"publisher","first-page":"790","DOI":"10.14744\/tjtes.2021.29540","article-title":"Mortality prediction models for severe burn patients: Which one is the best","volume":"28","author":"Yaz\u0131c\u0131","year":"2022","journal-title":"Ulus Travma Acil Cerrahi Derg"},{"key":"B56","doi-asserted-by":"publisher","first-page":"e656","DOI":"10.1097\/ccm.0000000000003144","article-title":"Comparative usefulness of sepsis-3, burn sepsis, and conventional sepsis criteria in patients with major burns","volume":"46","author":"Yoon","year":"2018","journal-title":"Crit. Care Med."},{"key":"B57","doi-asserted-by":"publisher","DOI":"10.1093\/burnst\/tkaa047","article-title":"The pathogenesis and diagnosis of sepsis post burn injury","volume":"9","author":"Zhang","year":"2021","journal-title":"Burns Trauma"}],"container-title":["Frontiers in Cellular and Infection Microbiology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcimb.2025.1586087\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,18]],"date-time":"2025-08-18T05:28:59Z","timestamp":1755494939000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcimb.2025.1586087\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,18]]},"references-count":57,"alternative-id":["10.3389\/fcimb.2025.1586087"],"URL":"https:\/\/doi.org\/10.3389\/fcimb.2025.1586087","relation":{},"ISSN":["2235-2988"],"issn-type":[{"value":"2235-2988","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,18]]},"article-number":"1586087"}}