Pathophysiologic response to severe burn injury

Marc G. Jeschke, David L. Chinkes, Celeste Finnerty, Gabriela Kulp, Oscar Suman, William Norbury, Ludwik Branski, Gerd G. Gauglitz, Ronald P. Mlcak, David Herndon

Research output: Contribution to journalArticle

319 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)387-400
Number of pages14
JournalAnnals of Surgery
Volume248
Issue number3
DOIs
StatePublished - Sep 2008

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Muscle Proteins
Body Surface Area
Wounds and Injuries
Bone Density
Length of Stay
Sepsis
Serum
Clinical Trials
Wound Infection
Proteome
Body Composition
Interleukin-8
Insulin Resistance
Interleukin-6
Leg
Demography
Hormones
Pediatrics
Cytokines
Morbidity

ASJC Scopus subject areas

  • Surgery

Cite this

Pathophysiologic response to severe burn injury. / Jeschke, Marc G.; Chinkes, David L.; Finnerty, Celeste; Kulp, Gabriela; Suman, Oscar; Norbury, William; Branski, Ludwik; Gauglitz, Gerd G.; Mlcak, Ronald P.; Herndon, David.

In: Annals of Surgery, Vol. 248, No. 3, 09.2008, p. 387-400.

Research output: Contribution to journalArticle

Jeschke, MG, Chinkes, DL, Finnerty, C, Kulp, G, Suman, O, Norbury, W, Branski, L, Gauglitz, GG, Mlcak, RP & Herndon, D 2008, 'Pathophysiologic response to severe burn injury', Annals of Surgery, vol. 248, no. 3, pp. 387-400. https://doi.org/10.1097/SLA.0b013e3181856241
Jeschke, Marc G. ; Chinkes, David L. ; Finnerty, Celeste ; Kulp, Gabriela ; Suman, Oscar ; Norbury, William ; Branski, Ludwik ; Gauglitz, Gerd G. ; Mlcak, Ronald P. ; Herndon, David. / Pathophysiologic response to severe burn injury. In: Annals of Surgery. 2008 ; Vol. 248, No. 3. pp. 387-400.
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abstract = "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.",
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AU - Chinkes, David L.

AU - Finnerty, Celeste

AU - Kulp, Gabriela

AU - Suman, Oscar

AU - Norbury, William

AU - Branski, Ludwik

AU - Gauglitz, Gerd G.

AU - Mlcak, Ronald P.

AU - Herndon, David

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N2 - 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.

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