Infection/Inflammation| Volume 163, ISSUE 2, P409-414, February 2018

Septic predictor index: A novel platform to identify thermally injured patients susceptible to sepsis

  • Author Footnotes
    1 These authors contributed equally.
    Peter Chen
    1 These authors contributed equally.
    Sunnybrook Research Institute, Toronto, Ontario, Canada
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  • Author Footnotes
    1 These authors contributed equally.
    Mile Stanojcic
    1 These authors contributed equally.
    Sunnybrook Research Institute, Toronto, Ontario, Canada
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  • Marc G. Jeschke
    Reprint requests: Marc G. Jeschke, MD, PhD, Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre; Division of Plastic Surgery, Department of Surgery, Department of Immunology, University of Toronto; Sunnybrook Research Institute, 2075 Bayview Ave., Rm D704, Toronto, Ontario, M4N 3M5, Canada.
    Sunnybrook Research Institute, Toronto, Ontario, Canada

    Division of Plastic Surgery Department of Surgery, University of Toronto, Toronto, Ontario, Canada

    Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
    Search for articles by this author
  • Author Footnotes
    1 These authors contributed equally.
Published:November 09, 2017DOI:


      During the past decades' sepsis has become the major cause of death in severely burned patients. Despite the importance of burn sepsis, its diagnosis, let alone its prediction, is difficult if not impossible. Recently, we have demonstrated burn patients have increased NLRP3 inflammasome activation in white adipose tissue. We aimed to delineate a unique immune profile that can be used to identify septic outcomes in severely burned patients.


      Adult burn patients (n = 37) admitted to our burn center between June 2013–2015 were enrolled in this study. White adipose tissue from the site of injury and plasma were collected from severely burned patients (>20% total body surface area) within 96 hours after thermal injury, indiscriminate of sex or age.


      We found that patients exhibiting aberrantly high levels of proinflammatory interleukin-1β and decreased macrophages at the site of injury are highly susceptible to development of sepsis. Septic patients also had increased anti-inflammatory (interleukin-10, interleukin-1RA) cytokines in plasma. The Septic Predictor Index was generated as a quotient for the site of injury macrophage proportion and interleukin-1β production. All patients who eventually develop sepsis had septic predictor index values >0.5. Septic patients with Septic Predictor Index values >1 all had sepsis onset within 12 days post-injury, whereas patients with Septic Predictor Index values between 0.5–1 all had later onset (>12 days).


      The Septic Predictor Index can determine sepsis onset accurately in thermally injured patients a priori and further enables surgeons to develop clinical studies and focused therapies specifically designed for septic cohorts.
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