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Are serum cytokines early predictors for the outcome of burn patients with inhalation injuries who do not survive?

Gauglitz GG, Finnerty CC, Herndon DN, Mlcak RP, Jeschke MG - Crit Care (2008)

Bottom Line: Severely burned patients suffering from inhalation injury have a significantly increased risk for mortality compared with burned patients without inhalation injury.Significantly altered levels of IL-4, IL-6, IL-7, IL-10, and IL-13 were detected within the first 7 days after admission in serum from burn pediatric patients with concomitant inhalation injury who did not survive when compared with similar patients who did (P < 0.05).Multiple logistic regression analysis revealed that patients with increased IL-6 and IL-10 as well as decreased IL-7 serum levels had a significantly greater risk for mortality (P < 0.05).

View Article: PubMed Central - HTML - PubMed

Affiliation: Shriners Hospitals for Children, 815 Market Street, Galveston, Texas, 77550, USA.

ABSTRACT

Introduction: Severely burned patients suffering from inhalation injury have a significantly increased risk for mortality compared with burned patients without inhalation injury. Severe burn is associated with a distinct serum cytokine profile and alterations in cytokines that contribute to morbidity and mortality. The aim of the present study was therefore to determine whether severely burned pediatric patients with concomitant inhalation injury who had a fatal outcome exhibited a different serum cytokine profile compared with burn patients with inhalation injury who survived. Early identification followed by appropriate management of these high-risk patients may lead to improved clinical outcome.

Methods: Thirteen severely burned children with inhalation injury who did not survive and 15 severely burned pediatric patients with inhalation injury who survived were enrolled in the study. Blood was collected within 24 hours of admission and 5 to 7 days later. Cytokine levels were profiled using multiplex antibody coated beads. Inhalation injury was diagnosed by bronchoscopy during the initial surgery. The number of days on the ventilator, peak inspiratory pressure rates, arterial oxygen tension (PaO2)/fraction of inspired oxygen (FiO2) ratio and incidence of acute respiratory distress syndrome were recorded for those patients.

Results: Significantly altered levels of IL-4, IL-6, IL-7, IL-10, and IL-13 were detected within the first 7 days after admission in serum from burn pediatric patients with concomitant inhalation injury who did not survive when compared with similar patients who did (P < 0.05). Alterations in these cytokines were associated with increased incidence of acute respiratory distress syndrome, number of days under ventilation, increased peak inspiratory pressure, and lower PaO2/FiO2 ratio in this patient population. Multiple logistic regression analysis revealed that patients with increased IL-6 and IL-10 as well as decreased IL-7 serum levels had a significantly greater risk for mortality (P < 0.05).

Conclusion: Early alterations in serum levels of IL-6, IL-7 and IL-10 may constitute useful predictive markers for identifying patients those who have sustained a burn with concomitant inhalation injury and who have high mortality.

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Related in: MedlinePlus

Outline of the study. The arterial oxygen tension (PaO2)/fraction of inspired oxygen (FiO2) ratio was measured in all patients within 24 hours after admission. Blood was drawn at hospital admission and 5 to 7 days afterward.
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Figure 1: Outline of the study. The arterial oxygen tension (PaO2)/fraction of inspired oxygen (FiO2) ratio was measured in all patients within 24 hours after admission. Blood was drawn at hospital admission and 5 to 7 days afterward.

Mentions: Inhalation injury was diagnosed by bronchoscopy, which was performed in all patients within 24 hours after admission in accordance with the following criteria (Figure 1): signs of exposure to smoke in an enclosed space, including presence of facial burns, singed nasal vibrissae, bronchorrhea, sooty sputum, and wheezing or rales upon auscultation; hypoxemia and/or elevated levels of carbon monoxide; and bronchoscopy findings of airway edema, inflammation, mucosal necrosis, presence of soot and charring in the airway, tissue sloughing, or carbonaceous material in the airway.


Are serum cytokines early predictors for the outcome of burn patients with inhalation injuries who do not survive?

Gauglitz GG, Finnerty CC, Herndon DN, Mlcak RP, Jeschke MG - Crit Care (2008)

Outline of the study. The arterial oxygen tension (PaO2)/fraction of inspired oxygen (FiO2) ratio was measured in all patients within 24 hours after admission. Blood was drawn at hospital admission and 5 to 7 days afterward.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2481480&req=5

Figure 1: Outline of the study. The arterial oxygen tension (PaO2)/fraction of inspired oxygen (FiO2) ratio was measured in all patients within 24 hours after admission. Blood was drawn at hospital admission and 5 to 7 days afterward.
Mentions: Inhalation injury was diagnosed by bronchoscopy, which was performed in all patients within 24 hours after admission in accordance with the following criteria (Figure 1): signs of exposure to smoke in an enclosed space, including presence of facial burns, singed nasal vibrissae, bronchorrhea, sooty sputum, and wheezing or rales upon auscultation; hypoxemia and/or elevated levels of carbon monoxide; and bronchoscopy findings of airway edema, inflammation, mucosal necrosis, presence of soot and charring in the airway, tissue sloughing, or carbonaceous material in the airway.

Bottom Line: Severely burned patients suffering from inhalation injury have a significantly increased risk for mortality compared with burned patients without inhalation injury.Significantly altered levels of IL-4, IL-6, IL-7, IL-10, and IL-13 were detected within the first 7 days after admission in serum from burn pediatric patients with concomitant inhalation injury who did not survive when compared with similar patients who did (P < 0.05).Multiple logistic regression analysis revealed that patients with increased IL-6 and IL-10 as well as decreased IL-7 serum levels had a significantly greater risk for mortality (P < 0.05).

View Article: PubMed Central - HTML - PubMed

Affiliation: Shriners Hospitals for Children, 815 Market Street, Galveston, Texas, 77550, USA.

ABSTRACT

Introduction: Severely burned patients suffering from inhalation injury have a significantly increased risk for mortality compared with burned patients without inhalation injury. Severe burn is associated with a distinct serum cytokine profile and alterations in cytokines that contribute to morbidity and mortality. The aim of the present study was therefore to determine whether severely burned pediatric patients with concomitant inhalation injury who had a fatal outcome exhibited a different serum cytokine profile compared with burn patients with inhalation injury who survived. Early identification followed by appropriate management of these high-risk patients may lead to improved clinical outcome.

Methods: Thirteen severely burned children with inhalation injury who did not survive and 15 severely burned pediatric patients with inhalation injury who survived were enrolled in the study. Blood was collected within 24 hours of admission and 5 to 7 days later. Cytokine levels were profiled using multiplex antibody coated beads. Inhalation injury was diagnosed by bronchoscopy during the initial surgery. The number of days on the ventilator, peak inspiratory pressure rates, arterial oxygen tension (PaO2)/fraction of inspired oxygen (FiO2) ratio and incidence of acute respiratory distress syndrome were recorded for those patients.

Results: Significantly altered levels of IL-4, IL-6, IL-7, IL-10, and IL-13 were detected within the first 7 days after admission in serum from burn pediatric patients with concomitant inhalation injury who did not survive when compared with similar patients who did (P < 0.05). Alterations in these cytokines were associated with increased incidence of acute respiratory distress syndrome, number of days under ventilation, increased peak inspiratory pressure, and lower PaO2/FiO2 ratio in this patient population. Multiple logistic regression analysis revealed that patients with increased IL-6 and IL-10 as well as decreased IL-7 serum levels had a significantly greater risk for mortality (P < 0.05).

Conclusion: Early alterations in serum levels of IL-6, IL-7 and IL-10 may constitute useful predictive markers for identifying patients those who have sustained a burn with concomitant inhalation injury and who have high mortality.

Show MeSH
Related in: MedlinePlus