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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

Nonsurviving pediatric patients with inhalation injury display more severe deterioration of lung function than their surviving counterparts. (a) The arterial oxygen tension (PaO2)/fraction of inspired oxygen (FiO2) ratio of severely burned children with inhalation injury who did not survive was lower than in those who survived (220 ± 27 mmHg versus 282 ± 23 mmHg). (b) Burn patients with inhalation injury who had a fatal outcome had significantly more ventilator days than children who survived (24 ± 5 days versus 5 ± 1 days). (c) Nonsurvivors exhibited significantly higher peak inspiratory pressure rates than survivors (71.5 ± 8.2 cmH2O versus 30.6 ± 2.1 cmH2O). (d) Severely burned children with concomitant inhalation injury who did not survive had a higher incidence of acute respiratory distress syndrome (ARDS) than did those who survived, which was not statistically significant (55.6% versus 27.7%). Bars represent means; error bars correspond to standard error of the mean. *P < 0.05.
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Figure 2: Nonsurviving pediatric patients with inhalation injury display more severe deterioration of lung function than their surviving counterparts. (a) The arterial oxygen tension (PaO2)/fraction of inspired oxygen (FiO2) ratio of severely burned children with inhalation injury who did not survive was lower than in those who survived (220 ± 27 mmHg versus 282 ± 23 mmHg). (b) Burn patients with inhalation injury who had a fatal outcome had significantly more ventilator days than children who survived (24 ± 5 days versus 5 ± 1 days). (c) Nonsurvivors exhibited significantly higher peak inspiratory pressure rates than survivors (71.5 ± 8.2 cmH2O versus 30.6 ± 2.1 cmH2O). (d) Severely burned children with concomitant inhalation injury who did not survive had a higher incidence of acute respiratory distress syndrome (ARDS) than did those who survived, which was not statistically significant (55.6% versus 27.7%). Bars represent means; error bars correspond to standard error of the mean. *P < 0.05.

Mentions: Severely burned children with inhalation injury who did not survive exhibited lower PaO2/FiO2 rates within 24 hours after hospital admission when compared with children who survived (Figure 2a). Burn patients with inhalation injury who had a fatal outcome exhibited a significantly (P < 0.05) greater number of days on the ventilator than did children who survived (Figure 2b). Significantly higher PIP rates were observed in nonsurvivors than in survivors (P < 0.05; data shown in Figure 2c). Severely burned children with concomitant inhalation injury who did not survive had a higher incidence of ARDS as compared with those who survived, but this difference was not statistically significant (55.6% versus 27.7%).


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)

Nonsurviving pediatric patients with inhalation injury display more severe deterioration of lung function than their surviving counterparts. (a) The arterial oxygen tension (PaO2)/fraction of inspired oxygen (FiO2) ratio of severely burned children with inhalation injury who did not survive was lower than in those who survived (220 ± 27 mmHg versus 282 ± 23 mmHg). (b) Burn patients with inhalation injury who had a fatal outcome had significantly more ventilator days than children who survived (24 ± 5 days versus 5 ± 1 days). (c) Nonsurvivors exhibited significantly higher peak inspiratory pressure rates than survivors (71.5 ± 8.2 cmH2O versus 30.6 ± 2.1 cmH2O). (d) Severely burned children with concomitant inhalation injury who did not survive had a higher incidence of acute respiratory distress syndrome (ARDS) than did those who survived, which was not statistically significant (55.6% versus 27.7%). Bars represent means; error bars correspond to standard error of the mean. *P < 0.05.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 2: Nonsurviving pediatric patients with inhalation injury display more severe deterioration of lung function than their surviving counterparts. (a) The arterial oxygen tension (PaO2)/fraction of inspired oxygen (FiO2) ratio of severely burned children with inhalation injury who did not survive was lower than in those who survived (220 ± 27 mmHg versus 282 ± 23 mmHg). (b) Burn patients with inhalation injury who had a fatal outcome had significantly more ventilator days than children who survived (24 ± 5 days versus 5 ± 1 days). (c) Nonsurvivors exhibited significantly higher peak inspiratory pressure rates than survivors (71.5 ± 8.2 cmH2O versus 30.6 ± 2.1 cmH2O). (d) Severely burned children with concomitant inhalation injury who did not survive had a higher incidence of acute respiratory distress syndrome (ARDS) than did those who survived, which was not statistically significant (55.6% versus 27.7%). Bars represent means; error bars correspond to standard error of the mean. *P < 0.05.
Mentions: Severely burned children with inhalation injury who did not survive exhibited lower PaO2/FiO2 rates within 24 hours after hospital admission when compared with children who survived (Figure 2a). Burn patients with inhalation injury who had a fatal outcome exhibited a significantly (P < 0.05) greater number of days on the ventilator than did children who survived (Figure 2b). Significantly higher PIP rates were observed in nonsurvivors than in survivors (P < 0.05; data shown in Figure 2c). Severely burned children with concomitant inhalation injury who did not survive had a higher incidence of ARDS as compared with those who survived, but this difference was not statistically significant (55.6% versus 27.7%).

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