Abstract
Severe burn injury renders patients susceptible to multiple infection episodes; however, identifying specific patient groups at high risk remains challenging. Burn-induced inflammatory response dramatically modifies the levels of various cytokines. Whether these changes could predict susceptibility to infections remains unknown. The aim of this study was to determine the early changes in the pro- to anti-inflammatory cytokine ratio and investigate its ability to predict susceptibility to repeated infections after severe burn trauma. The patient population consisted of 34 adult patients having early (≤48 h since injury) blood draws following severe (≥20% total burn surface area (TBSA)) burn injury and suffering from a first infection episode at least 1 day after blood collection. Plasma TNF-α and IL-10 levels were measured to explore the association between the TNF-α/IL-10 ratio, hypersusceptibility to infections, burn size (TBSA), and common severity scores (Acute Physiology and Chronic Health Evaluation II (APACHEII), Baux, modified Baux (R-Baux), Ryan Score, and Abbreviated Burn Severity Index (ABSI)). TNF-α/IL10 plasma ratio measured shortly after burn trauma was inversely correlated with burn size and the injury severity scores investigated, and was predictive of repeated infections (≥3 infection episodes) outcome (AUROC [95%CI] of 0.80 [0.63–0.93]). Early measures of circulating TNF-α/IL10 ratio may be a previously unidentified biomarker associated with burn injury severity and predictive of the risk of hypersusceptibility to repeated infections.
Highlights
Burn injury, one of the major causes of trauma-related mortality worldwide, is a significant global public health concern [1]
Our study is comprised of extensively burned patients, with patients suffering from a mean total burn surface area (TBSA) of 41.6 ± 18.8% with the great majority presenting with third-degree burns (91.2%)
Our study demonstrates that burn trauma severity is inversely correlated with early blood plasma pro- to anti-inflammatory signaling ratio, perhaps due to a state of immunosuppression that accompanies severe trauma
Summary
One of the major causes of trauma-related mortality worldwide, is a significant global public health concern [1]. While the majority of burn patients no longer die directly from the shock induced by the burn trauma as a result of advances in modern resuscitation measures, infections and infection-related complications developed days after admission continue to pose significant risks to patients’ lives [2]. Considering this negative impact of burn-related infections on mortality, patient recovery, and health-care costs, it is crucial to develop novel methods to detect and manage specific patients with increased risk of infection [3]. It is of interest to develop early biomarkers that may further improve the identification of the subset of patients at risk of infection and related outcomes among a population of extensively burned patients, who are especially susceptible
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