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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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Related in: MedlinePlus

Severe burn leads to markedly increased inflammatory response.Fourteen cytokines measured within this study were significantly altered in response to burn injury. Particularly serum IL-6, IL-8, G-CSF and MCP-1 revealed dramatic increases. IL-12p70 and MIP-1β were not significantly altered in response to burn trauma when compared to controls. Histograms depict serum concentrations of the respective cytokine at steady state levels. 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-g003: Severe burn leads to markedly increased inflammatory response.Fourteen cytokines measured within this study were significantly altered in response to burn injury. Particularly serum IL-6, IL-8, G-CSF and MCP-1 revealed dramatic increases. IL-12p70 and MIP-1β were not significantly altered in response to burn trauma when compared to controls. Histograms depict serum concentrations of the respective cytokine at steady state levels. 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: We found that almost all cytokines measured within this study were significantly altered in response to burn injury (Fig. 3A–Q). Dramatic changes were observed for serum IL-6, IL-8, G-CSF and MCP-1 (Fig. 3C, D, M, N). These cytokines demonstrated an up to 2,000-fold increase immediately upon burn trauma and remained significantly elevated throughout the time period studied when compared with the concentrations detected in non-burned controls, p<0.05. GM-CSF, INF-γ, TNF-α, IL-1β, IL-2, IL-5, IL-7, IL-10, and IL-17 significantly increased by 2- to 20-fold in response to burn injury and revealed relatively constant, but significantly increased levels for most of the three-year period post-burn compared to non-burned patients (p<0.05). IL-12p70 and MIP-1β were not significantly altered in response to burn trauma when compared to controls.


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)

Severe burn leads to markedly increased inflammatory response.Fourteen cytokines measured within this study were significantly altered in response to burn injury. Particularly serum IL-6, IL-8, G-CSF and MCP-1 revealed dramatic increases. IL-12p70 and MIP-1β were not significantly altered in response to burn trauma when compared to controls. Histograms depict serum concentrations of the respective cytokine at steady state levels. Bars represent means; error bars correspond to S.E.M. Asterisks denote statistical difference between burned children vs. non-burned children, p<0.05.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3138751&req=5

pone-0021245-g003: Severe burn leads to markedly increased inflammatory response.Fourteen cytokines measured within this study were significantly altered in response to burn injury. Particularly serum IL-6, IL-8, G-CSF and MCP-1 revealed dramatic increases. IL-12p70 and MIP-1β were not significantly altered in response to burn trauma when compared to controls. Histograms depict serum concentrations of the respective cytokine at steady state levels. 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: We found that almost all cytokines measured within this study were significantly altered in response to burn injury (Fig. 3A–Q). Dramatic changes were observed for serum IL-6, IL-8, G-CSF and MCP-1 (Fig. 3C, D, M, N). These cytokines demonstrated an up to 2,000-fold increase immediately upon burn trauma and remained significantly elevated throughout the time period studied when compared with the concentrations detected in non-burned controls, p<0.05. GM-CSF, INF-γ, TNF-α, IL-1β, IL-2, IL-5, IL-7, IL-10, and IL-17 significantly increased by 2- to 20-fold in response to burn injury and revealed relatively constant, but significantly increased levels for most of the three-year period post-burn compared to non-burned patients (p<0.05). IL-12p70 and MIP-1β were not significantly altered in response to burn trauma when compared to controls.

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