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Early pulmonary immune hyporesponsiveness is associated with mortality after burn and smoke inhalation injury. J Burn Care Res 2012 Jan-Feb;33(1):26-35

Date

10/08/2011

Pubmed ID

21979852

Pubmed Central ID

PMC3253958

DOI

10.1097/BCR.0b013e318234d903

Scopus ID

2-s2.0-84855785947   28 Citations

Abstract

This prospective study aims to address mortality in the context of the early pulmonary immune response to burn and inhalation injury. The authors collected bronchoalveolar lavage fluid from 60 burn patients within 14 hours of their injury when smoke inhalation was suspected. Clinical and laboratory parameters and immune mediator profiles were compared with patient outcomes. Patients who succumbed to their injuries were older (P = .005), had a larger % TBSA burn (P < .001), and required greater 24-hour resuscitative fluids (P = .002). Nonsurvivors had lower bronchoalveolar lavage fluid concentrations of numerous immunomodulators, including C5a, interleukin (IL)-1β, IL-1RA, IL-8, IL-10, and IL-13 (P < .05 for all). Comparing only those with the highest Baux scores to account for the effects of age and % TBSA burn on mortality, nonsurvivors also had reduced levels of IL-2, IL-4, granulocyte colony-stimulating factor, interferon-γ, macrophage inflammatory protein-1β, and tumor necrosis factor-α (P < .05 for all). The apparent pulmonary immune hyporesponsiveness in those who died was confirmed by in vitro culture, which revealed that pulmonary leukocytes from nonsurvivors had a blunted production of numerous immune mediators. This study demonstrates that the early pulmonary immune response to burn and smoke inhalation may be attenuated in patients who succumb to their injuries.

Author List

Davis CS, Albright JM, Carter SR, Ramirez L, Kim H, Gamelli RL, Kovacs EJ

Author

Christopher Stephen Davis MD, MPH Assistant Professor in the Surgery department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Adult
Age Factors
Aged
Aged, 80 and over
Biomarkers
Bronchoalveolar Lavage Fluid
Bronchoscopy
Burns
Cause of Death
Cohort Studies
Confidence Intervals
Female
Humans
Immune Tolerance
Injury Severity Score
Interleukins
Logistic Models
Lung
Male
Middle Aged
Odds Ratio
Prognosis
Risk Assessment
Smoke Inhalation Injury
Survival Rate
Time Factors
jenkins-FCD Prod-482 91ad8a360b6da540234915ea01ff80e38bfdb40a