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Long-term persistance of the pathophysiologic response to severe burn injury.

Jeschke MG, Gauglitz GG, Kulp GA, Finnerty CC, Williams FN, Kraft R, Suman OE, Mlcak RP, Herndon DN - PLoS ONE (2011)

Bottom Line: Demographics and clinical outcomes, hypermetabolism, body composition, organ function, inflammatory and acute phase responses were determined at admission and subsequent regular intervals for up to 36 months post-burn.Resting energy expenditure, body composition, metabolic markers, cardiac and organ function clearly demonstrated that burn caused profound alterations for up to three years post-burn demonstrating marked and prolonged hypermetabolism, p<0.05.Severe burn injury leads to a much more profound and prolonged hypermetabolic and hyperinflammatory response than previously shown.

View Article: PubMed Central - PubMed

Affiliation: Shriners Hospitals for Children, University of Texas Medical Branch, Galveston, Texas, United States of America. marc.jeschke@sunnybrook.ca

ABSTRACT

Background: Main contributors to adverse outcomes in severely burned pediatric patients are profound and complex metabolic changes in response to the initial injury. It is currently unknown how long these conditions persist beyond the acute phase post-injury. The aim of the present study was to examine the persistence of abnormalities of various clinical parameters commonly utilized to assess the degree hypermetabolic and inflammatory alterations in severely burned children for up to three years post-burn to identify patient specific therapeutic needs and interventions.

Patients: Nine-hundred seventy-seven severely burned pediatric patients with burns over 30% of the total body surface admitted to our institution between 1998 and 2008 were enrolled in this study and compared to a cohort non-burned, non-injured children. Demographics and clinical outcomes, hypermetabolism, body composition, organ function, inflammatory and acute phase responses were determined at admission and subsequent regular intervals for up to 36 months post-burn. Statistical analysis was performed using One-way ANOVA, Student's t-test with Bonferroni correction where appropriate with significance accepted at p<0.05. Resting energy expenditure, body composition, metabolic markers, cardiac and organ function clearly demonstrated that burn caused profound alterations for up to three years post-burn demonstrating marked and prolonged hypermetabolism, p<0.05. Along with increased hypermetabolism, significant elevation of cortisol, catecholamines, cytokines, and acute phase proteins indicate that burn patients are in a hyperinflammatory state for up to three years post-burn p<0.05.

Conclusions: Severe burn injury leads to a much more profound and prolonged hypermetabolic and hyperinflammatory response than previously shown. Given the tremendous adverse events associated with the hypermetabolic and hyperinflamamtory responses, we now identified treatment needs for severely burned patients for a much more prolonged time.

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Persistently increased percent predicted REE indicate prolonged hypermetabolism (A).REE % predicted increases upon burn injury and decreased over time but remains significantly elevated up to two years post-injury. Bars represent means; error bars correspond to S.E.M. Asterisks denote statistical difference between burned children vs. normal range, p<0.05. Body composition, weights and heights: Bone mineral content (B), LBM (C), fat (D, E) and BMD (F, G) were measured at admission and subsequent time points. DEXA analysis revealed significantly decreased values throughout the whole time period studied for BMC, LBM, and fat, p<0.05. Cardiac function and liver size post-burn: Percent predicted cardiac output (H) and cardiac index (I) were significantly increased for up to 12 months post-burn. Heart rate (J) was twice that of non-burned children for up to three years post-burn, while predicted stroke volume (K) was normal. Liver size increased by nearly two-fold upon burn injury of predicted liver size and remained elevated for the remaining of the study (L). Bars represent means; error bars correspond to S.E.M. Asterisks denote statistical difference between burned children vs. non-burned children, p<0.05.
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pone-0021245-g001: Persistently increased percent predicted REE indicate prolonged hypermetabolism (A).REE % predicted increases upon burn injury and decreased over time but remains significantly elevated up to two years post-injury. Bars represent means; error bars correspond to S.E.M. Asterisks denote statistical difference between burned children vs. normal range, p<0.05. Body composition, weights and heights: Bone mineral content (B), LBM (C), fat (D, E) and BMD (F, G) were measured at admission and subsequent time points. DEXA analysis revealed significantly decreased values throughout the whole time period studied for BMC, LBM, and fat, p<0.05. Cardiac function and liver size post-burn: Percent predicted cardiac output (H) and cardiac index (I) were significantly increased for up to 12 months post-burn. Heart rate (J) was twice that of non-burned children for up to three years post-burn, while predicted stroke volume (K) was normal. Liver size increased by nearly two-fold upon burn injury of predicted liver size and remained elevated for the remaining of the study (L). Bars represent means; error bars correspond to S.E.M. Asterisks denote statistical difference between burned children vs. non-burned children, p<0.05.

Mentions: Predicted REE increased significantly post-burn and then gradually decreased over time, but remained significantly elevated for two years following burn injury indicating marked hypermetabolism, p<0.05 (Fig. 1A).


Long-term persistance of the pathophysiologic response to severe burn injury.

Jeschke MG, Gauglitz GG, Kulp GA, Finnerty CC, Williams FN, Kraft R, Suman OE, Mlcak RP, Herndon DN - PLoS ONE (2011)

Persistently increased percent predicted REE indicate prolonged hypermetabolism (A).REE % predicted increases upon burn injury and decreased over time but remains significantly elevated up to two years post-injury. Bars represent means; error bars correspond to S.E.M. Asterisks denote statistical difference between burned children vs. normal range, p<0.05. Body composition, weights and heights: Bone mineral content (B), LBM (C), fat (D, E) and BMD (F, G) were measured at admission and subsequent time points. DEXA analysis revealed significantly decreased values throughout the whole time period studied for BMC, LBM, and fat, p<0.05. Cardiac function and liver size post-burn: Percent predicted cardiac output (H) and cardiac index (I) were significantly increased for up to 12 months post-burn. Heart rate (J) was twice that of non-burned children for up to three years post-burn, while predicted stroke volume (K) was normal. Liver size increased by nearly two-fold upon burn injury of predicted liver size and remained elevated for the remaining of the study (L). Bars represent means; error bars correspond to S.E.M. Asterisks denote statistical difference between burned children vs. non-burned children, p<0.05.
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Related In: Results  -  Collection

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getmorefigures.php?uid=PMC3138751&req=5

pone-0021245-g001: Persistently increased percent predicted REE indicate prolonged hypermetabolism (A).REE % predicted increases upon burn injury and decreased over time but remains significantly elevated up to two years post-injury. Bars represent means; error bars correspond to S.E.M. Asterisks denote statistical difference between burned children vs. normal range, p<0.05. Body composition, weights and heights: Bone mineral content (B), LBM (C), fat (D, E) and BMD (F, G) were measured at admission and subsequent time points. DEXA analysis revealed significantly decreased values throughout the whole time period studied for BMC, LBM, and fat, p<0.05. Cardiac function and liver size post-burn: Percent predicted cardiac output (H) and cardiac index (I) were significantly increased for up to 12 months post-burn. Heart rate (J) was twice that of non-burned children for up to three years post-burn, while predicted stroke volume (K) was normal. Liver size increased by nearly two-fold upon burn injury of predicted liver size and remained elevated for the remaining of the study (L). Bars represent means; error bars correspond to S.E.M. Asterisks denote statistical difference between burned children vs. non-burned children, p<0.05.
Mentions: Predicted REE increased significantly post-burn and then gradually decreased over time, but remained significantly elevated for two years following burn injury indicating marked hypermetabolism, p<0.05 (Fig. 1A).

Bottom Line: Demographics and clinical outcomes, hypermetabolism, body composition, organ function, inflammatory and acute phase responses were determined at admission and subsequent regular intervals for up to 36 months post-burn.Resting energy expenditure, body composition, metabolic markers, cardiac and organ function clearly demonstrated that burn caused profound alterations for up to three years post-burn demonstrating marked and prolonged hypermetabolism, p<0.05.Severe burn injury leads to a much more profound and prolonged hypermetabolic and hyperinflammatory response than previously shown.

View Article: PubMed Central - PubMed

Affiliation: Shriners Hospitals for Children, University of Texas Medical Branch, Galveston, Texas, United States of America. marc.jeschke@sunnybrook.ca

ABSTRACT

Background: Main contributors to adverse outcomes in severely burned pediatric patients are profound and complex metabolic changes in response to the initial injury. It is currently unknown how long these conditions persist beyond the acute phase post-injury. The aim of the present study was to examine the persistence of abnormalities of various clinical parameters commonly utilized to assess the degree hypermetabolic and inflammatory alterations in severely burned children for up to three years post-burn to identify patient specific therapeutic needs and interventions.

Patients: Nine-hundred seventy-seven severely burned pediatric patients with burns over 30% of the total body surface admitted to our institution between 1998 and 2008 were enrolled in this study and compared to a cohort non-burned, non-injured children. Demographics and clinical outcomes, hypermetabolism, body composition, organ function, inflammatory and acute phase responses were determined at admission and subsequent regular intervals for up to 36 months post-burn. Statistical analysis was performed using One-way ANOVA, Student's t-test with Bonferroni correction where appropriate with significance accepted at p<0.05. Resting energy expenditure, body composition, metabolic markers, cardiac and organ function clearly demonstrated that burn caused profound alterations for up to three years post-burn demonstrating marked and prolonged hypermetabolism, p<0.05. Along with increased hypermetabolism, significant elevation of cortisol, catecholamines, cytokines, and acute phase proteins indicate that burn patients are in a hyperinflammatory state for up to three years post-burn p<0.05.

Conclusions: Severe burn injury leads to a much more profound and prolonged hypermetabolic and hyperinflammatory response than previously shown. Given the tremendous adverse events associated with the hypermetabolic and hyperinflamamtory responses, we now identified treatment needs for severely burned patients for a much more prolonged time.

Show MeSH
Related in: MedlinePlus