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Citation
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Penatzer JA, Wala SJ, Barash B, Alexander R, Hensley J, Wolfe A, Fabia R, Hall M, Thakkar RK. Shock 2022; ePub(ePub): ePub. |
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Abstract
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BACKGROUND: There is currently no standard definition of a severe burn in the pediatric patient population to identify those at higher risk of infectious complications. Our aim was to correlate total burn surface area (TBSA), burn depth, and type of burn injury to nosocomial infection rates and systemic immune system responses to better define risk factors associated with adverse outcomes.
METHODS: A prospective observational study at a single-center, quaternary-care, American Burn Association-verified Pediatric Burn Center was conducted from 2016-2021. Blood was collected within 72 hours of injury from 103 pediatric patients. Whole blood was incubated with lipopolysaccharide or phytohemagglutinin stimulation reagent to measure innate and adaptive immune response, respectively. Flow cytometry was performed on whole blood samples to measure both innate and adaptive immune cells. Unstimulated plasma was also extracted, and IL-6 and IL-10, as well as soluble proteins B- and T-lymphocyte attenuator, CD27, and T-cell immunoglobulin mucin-3 were quantified.
RESULTS: There was a significant increased risk for nosocomial infection in pediatric patients with TBSA burns of ≥20%, full thickness burn injuries ≥5%, or flame burn injuries. There was an overall decrease in both innate and adaptive immune function in patients with TBSA burns ≥20% or full thickness burn injuries ≥5%. Both burn injury characteristics were also associated with a significant increase in unstimulated IL-6 and 10 and soluble immunoregulatory checkpoint proteins. We observed a significant decrease in soluble BTLA for those with a flame injury, but there were no other differences between flame injury and scald/contact burns in terms of innate and adaptive immune function.
CONCLUSIONS: Burns with ≥20% TBSA or ≥ 5% full thickness in pediatric patients are associated with systemic immune dysfunction as well as increased risk of nosocomial infections.
Language: en |