232 Toxic Compounds in Burn Patients with Smoke Inhalation Injury

Abstract

Current advanced analytical methods allow for the detection of volatile organic compounds (VOC) levels in blood and enable exploration of VOCs and their potential effects. National Health and Nutrition Examination Survey (NHANES) released data in the public domain for 33 analytes of blood VOC levels for a sample representative of the U.S. population for years 2007–2008. The goal of this study was to use data from NHANES 2007–2008 to evaluate the variability in concentration levels of selected VOC analytes (known toxicants in cigarettes) between the general U.S. population and burn victims with smoke inhalation. After IRB approval, blood samples were obtained from burn victims with smoke inhalation injury at our institution from 2008 to present. NHANES data was used for control comparisons. Subjects in the NHANES dataset were matched to subjects in the burn victim dataset based on age, gender and race in a 1:1 ratio (n=23 per group). The analysis focus was placed on seven biomarkers: benzene (VBZ), toluene (VTO), ethylbenzene (VEB), m-/p-xylene (VXY), o-xylene (VOX), styrene (VST), and 2-5-dimethylfuran (2DF) - all of which are well-known toxicants in tobacco smoke. 1,2-dichloroethane (V2A) is not associated with tobacco smoke but was included as a burn victim positive control. . SAS version 9.4 proc ttest was used for univariate analysis of log transformed values of the seven analytes of interest. Cigarette smokers identified by questionnaire were found to have significantly higher blood VOC levels for the seven smoke biomarkers than non-smokers in NHANES data. However, no significant statistical difference was found in blood VOC levels between smokers and nonsmokers among burn victims. Nevertheless, among the matched data, burn victims with smoke inhalation were found to have statistically significantly higher blood VOC levels for: VBZ (p 0.0258), VOX (p 0.0006), VST (p 0.0010), and positive control V2A (<.0001) than NHANES smokers. Although not statically significant, burn victims with smoke inhalation were also found to have higher blood VOC levels than NHANES smokers for VTO, VEB and VXY. The data presented here add to the knowledge about exposure of VOCs among house-fire burn victims with smoke inhalation injury. The most significant finding of this study was that smoke inhalation from house-fire was associated with relatively higher levels of VOC toxicants when compared to cigarette smokers of the U.S. general population. Further investigation is warranted to determine if there is a correlation of elevated VOCs and clinical prognosis. Identification of VOCs that may exacerbate smoke inhalation injury may help develop more sensitive diagnostic tools to help determine severity and/or outcome of an individual’s smoke inhalation injury.