Determinants of muscle protein synthesis in severe pediatric burns (703.5)

Abstract

Introduction: Following a major burn, a large increase in skeletal muscle protein breakdown is seen. The simultaneous increase in muscle protein synthesis cannot completely compensate for the breakdown, resulting in net protein loss. The aim of this study was to identify the determinants of skeletal muscle protein fractional synthetic rate (FSR) in severely burned children. Methods: 87 patients with 蠅40% Total Body Surface Area (TBSA) burns were included. Patients participated in stable isotope infusion studies during their acute hospitalization and at 6, 12 and 24 months post injury in order to determine skeletal muscle FSR. Generalized estimating equations with log link normal distribution were applied to account for clustering of patients and control for patient characteristics. Results: Patients (8±6 yr) had large (59±14 % TBSA), deep (47±21% 3rd degree) burns. Time was a significant determinant, with a decrease in FSR [%/h, median (Q1‐Q3)] at 12 months vs. admission [0.08 (0.05‐0.18)vs. 0.12 (0.07‐.0.24)] (P<0.05). Further, FSR was 48% higher in childrenwith co‐existent inhalation injury vs. those with burn injury alone. Inaddition, FSR was 36% lower in male vs female kids, while children >3 years had 30% lower FSR values than younger children. Finally, FSR was significantly lower in patients with burns 蠅60% TBSA. Conclusion: The current data demonstrate that burn size, gender; the presence of inhalation injury and time all affect the rate of skeletal muscle FSR following burn injury. The impact of these findings on net protein balance remains unknown and warrants further investigation.Grant Funding Source: Supported by NIH P50‐GM60338, RO1‐GM056687, T32‐GM008256, and Shriners grants 84090, 84080, 71006/08