Abstract： Objective:To investigate the risk factors affecting the prognosis of patients with extremely severe burns.Methods:Totally 46 patients with extremely severe burn in the dust explosion of aluminum powder in Kunshan, Jiangsu province on August 2, 2014 were included in this study. The patients were divided into the survival group and death group according to the prognosis of the patients. The patients' age, sex, burn degree, white blood cell, and lactic acid at admission, lactic acid at 48 h, creatinine, albumin, urine volume, blood calcium, acute physiology and chronic health score system II (APACHE II) and SOFA scores, and 90 d mortality were collected. COX regression analysis was used to analyze the possible relationship between the indicators of the two groups and the prognosis.Results:There were no significant differences in white blood cell at admission, creatinine, albumin, urine volume, SOFA score, and APACHE II score in the survival group compared with those in the death group (all P>0.05) and burn degree, the levels of lactic acid at admission, lactic acid at 48 h and blood calcium were significantly different (all P<0.05). Multivariate regression analysis showed that age, albumin and lactic acid at 48 h were independent predictors of death in patients with severe burn ( P<0.05), and these are independent outcome predictors of patients with severe burns ( P<0.05). Conclusions:Age, albumin level and lactic acid at 48 h are independent risk factors affecting the prognosis of patients with severe burns.