Increased inflammatory markers found in nonsurviving pediatric burn patients

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1. Compared with pediatric burn patients who survived, those who did not had significantly higher levels of serum inflammatory markers, including IL-6, IL-8, G-CSF, and CRP. 

2. Nonsurviving pediatric burn patients also had 10% greater resting energy expenditure (REE) and 40% higher cardiac output than surviving patients, indicating a hypermetabolic state. 

Evidence Rating Level: 2 (Good) 

Study Rundown: There are several known risk factors determining survival after a severe burn, including age, inhalation injury, burn size, and sepsis. Another determining factor is post-burn hypermetabolic response, which causes protein catabolism and organ dysfunction. This study demonstrated an increased pattern of serum inflammatory cytokine and acute phase protein expression between surviving and nonsurviving pediatric burn patients, as well as a markedly increased hypermetabolic response in nonsurvivors.

One limitation of the study is that the exclusion criteria were not defined. Furthermore, the study is not generalizable to an adult population. While the authors allude to a method of using proteomics to increase overall outcome prediction accuracy, it is not clear how to use the data to monitor patient progress since values for stratifying risk were not identified. Future studies could assess the predictive value of a clinical prediction rule to identify higher risk burn patients.

Click to read the study in Annals of Surgery

Relevant Reading: Age differences in inflammatory and hypermetabolic postburn responses

In-Depth [prospective cohort study]: This study examined 230 thermally injured pediatric patients over a 12 year period with burns covering at least 30% of total body surface area. All patients received the same nutritional treatment in accordance with a standardized protocol. REE was determined via indirect calorimetry and cardiac function was measured by echocardiogram.

In total, 34% total enrolled patients died within 300 days of the burn injury. Serum cytokines IL-6, IL-8, G-CSF and MCP-1 were drastically higher in nonsurvivors, by up to 10000 fold (P<0.05). Acute phase proteins C-reactive protein and hepatic retinol-binding protein were significantly higher in nonsurvivors (P<0.05). Serum glucose and insulin levels were also elevated in nonsurvivors (P<0.05). Measures of hypermetabolic response increased in nonsurvivors. REE was 10% higher in nonsurvivors at discharge. Cardiac output was 40% higher in nonsurvivors, and stroke volume as 40% higher (P<0.05).

By James Jiang and Allen Ho

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