Background
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.
Methods
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.
Results
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).
Conclusion
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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Article info
Publication history
Published online: November 09, 2017
Accepted:
August 30,
2017
Footnotes
Supported by grants from the Canadian Institutes of Health Research (123336), Canadian Foundation for Innovation Leader's Opportunity Fund (Project #25407), National Institutes of Health (2R01GM087285-05A1, R01 GM087285-01), and Physicians' Services Incorporated Foundation: Health Research Grant Program.
Identification
Copyright
© 2017 Elsevier Inc. All rights reserved.
