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Pathophysiologic Response to Severe Burn Injury

Jeschke, Marc G. MD, PhD*†; Chinkes, David L. PhD*†; Finnerty, Celeste C. PhD*†; Kulp, Gabriela MS*; Suman, Oscar E. PhD*†; Norbury, William B. MD*; Branski, Ludwik K. MD*; Gauglitz, Gerd G. MD*; Mlcak, Ronald P. PhD*; Herndon, David N. MD, FACS*†

doi: 10.1097/SLA.0b013e3181856241
Original Articles

Objective: To improve clinical outcome and to determine new treatment options, we studied the pathophysiologic response postburn in a large prospective, single center, clinical trial.

Summary Background Data: A severe burn injury leads to marked hypermetabolism and catabolism, which are associated with morbidity and mortality. The underlying pathophysiology and the correlations between humoral changes and organ function have not been well delineated.

Methods: Two hundred forty-two severely burned pediatric patients [>30% total body surface area (TBSA)], who received no anabolic drugs, were enrolled in this study. Demographics, clinical data, serum hormones, serum cytokine expression profile, organ function, hypermetabolism, muscle protein synthesis, incidence of wound infection sepsis, and body composition were obtained throughout acute hospital course.

Results: Average age was 8 ± 0.2 years, and average burn size was 56 ± 1% TBSA with 43 ± 1% third-degree TBSA. All patients were markedly hypermetabolic throughout acute hospital stay and had significant muscle protein loss as demonstrated by a negative muscle protein net balance (−0.05% ± 0.007 nmol/100 mL leg/min) and loss of lean body mass (LBM) (−4.1% ± 1.9%); P < 0.05. Patients lost 3% ± 1% of their bone mineral content (BMC) and 2 ± 1% of their bone mineral density (BMD). Serum proteome analysis demonstrated profound alterations immediately postburn, which remained abnormal throughout acute hospital stay; P < 0.05. Cardiac function was compromised immediately after burn and remained abnormal up to discharge; P < 0.05. Insulin resistance appeared during the first week postburn and persisted until discharge. Patients were hyperinflammatory with marked changes in IL-8, MCP-1, and IL-6, which were associated with 2.5 ± 0.2 infections and 17% sepsis.

Conclusions: In this large prospective clinical trial, we delineated the complexity of the postburn pathophysiologic response and conclude that the postburn response is profound, occurring in a timely manner, with derangements that are greater and more protracted than previously thought.

In this large prospective clinical trial, we delineated the complexity of the postburn pathophysiologic response and conclude that this response is profound, occurring in a timely manner, with derangements that are greater and more protracted than previously thought.

From the *Shriners Hospitals for Children and †Department of Surgery, University Texas Medical Branch, Galveston, Texas.

This study was supported by the American Surgical Association Foundation, Shriners Hospitals for Children 8660, 8760, and 9145, NIH R01-GM56687, T32 GM008256, and P50 GM603384908, and NIDRR H133A020102.

M.G.J. and D.N.H. contributed equally to this work.

The registration number in ClinicalTrials.gov for this study is NCT00673309.

Reprints: Marc G. Jeschke, MD, PhD, Shriners Hospitals for Children, 815 Market Street, Galveston, TX 77550. E-mail: majeschk@utmb.edu.

© 2008 Lippincott Williams & Wilkins, Inc.