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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

Hepatic enzymes and proteins.Histograms depict serum concentrations of Alanin-Aminotransferase (ALT) (A), aspartat-aminotransferase (AST) (B), albumin (ALB) (C), alkaline phosphatase (ALP) (D), glutamyl transpeptidase (GGT) (E), and serum calcium concentrations (F). Serum IGF-I (G), IGFBP-3 (H), GH (I), iPTH (J), osteocalcin (K), EST (L) were significantly decreased in response to thermal injury and remained diminished for up to three years post-burn. Analysis of serum testosterone (M) and progesterone (N) revealed only moderate increases throughout the first two months post-burn. 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-g005: Hepatic enzymes and proteins.Histograms depict serum concentrations of Alanin-Aminotransferase (ALT) (A), aspartat-aminotransferase (AST) (B), albumin (ALB) (C), alkaline phosphatase (ALP) (D), glutamyl transpeptidase (GGT) (E), and serum calcium concentrations (F). Serum IGF-I (G), IGFBP-3 (H), GH (I), iPTH (J), osteocalcin (K), EST (L) were significantly decreased in response to thermal injury and remained diminished for up to three years post-burn. Analysis of serum testosterone (M) and progesterone (N) revealed only moderate increases throughout the first two months post-burn. 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: Serum concentrations of Alanin-Aminotransferase (ALT) and aspartat-aminotransferase (AST) significantly increased immediately upon burn trauma and remained significantly elevated for the remaining of the study period, p<0.05 (Fig. 5A, B). Serum Albumin (ALB) concentrations demonstrated significantly decreased levels for the entire three-year period compared to non-burned controls, p<0.05 (Fig. 5C). Both, alkaline phosphatase (ALP) and gamma glutamyl transpeptidase (GGT) were significantly altered in response to burn. While ALP displayed significantly elevated levels starting 8 days post-burn injury, which remained significantly elevated for the remaining of the study, serum concentrations of GGT raised to significant values beginning eight days post-burn before rapidly decreasing to normal concentrations beginning 90 days post-trauma, p<0.05 (Fig. 5D, E). Serum calcium concentrations, however, displayed significantly decreased levels for the entire three-year period, p<0.05 (Fig. 5F).


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)

Hepatic enzymes and proteins.Histograms depict serum concentrations of Alanin-Aminotransferase (ALT) (A), aspartat-aminotransferase (AST) (B), albumin (ALB) (C), alkaline phosphatase (ALP) (D), glutamyl transpeptidase (GGT) (E), and serum calcium concentrations (F). Serum IGF-I (G), IGFBP-3 (H), GH (I), iPTH (J), osteocalcin (K), EST (L) were significantly decreased in response to thermal injury and remained diminished for up to three years post-burn. Analysis of serum testosterone (M) and progesterone (N) revealed only moderate increases throughout the first two months post-burn. 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-g005: Hepatic enzymes and proteins.Histograms depict serum concentrations of Alanin-Aminotransferase (ALT) (A), aspartat-aminotransferase (AST) (B), albumin (ALB) (C), alkaline phosphatase (ALP) (D), glutamyl transpeptidase (GGT) (E), and serum calcium concentrations (F). Serum IGF-I (G), IGFBP-3 (H), GH (I), iPTH (J), osteocalcin (K), EST (L) were significantly decreased in response to thermal injury and remained diminished for up to three years post-burn. Analysis of serum testosterone (M) and progesterone (N) revealed only moderate increases throughout the first two months post-burn. 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: Serum concentrations of Alanin-Aminotransferase (ALT) and aspartat-aminotransferase (AST) significantly increased immediately upon burn trauma and remained significantly elevated for the remaining of the study period, p<0.05 (Fig. 5A, B). Serum Albumin (ALB) concentrations demonstrated significantly decreased levels for the entire three-year period compared to non-burned controls, p<0.05 (Fig. 5C). Both, alkaline phosphatase (ALP) and gamma glutamyl transpeptidase (GGT) were significantly altered in response to burn. While ALP displayed significantly elevated levels starting 8 days post-burn injury, which remained significantly elevated for the remaining of the study, serum concentrations of GGT raised to significant values beginning eight days post-burn before rapidly decreasing to normal concentrations beginning 90 days post-trauma, p<0.05 (Fig. 5D, E). Serum calcium concentrations, however, displayed significantly decreased levels for the entire three-year period, p<0.05 (Fig. 5F).

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