Cytokines and growth factors in children with burns, relation to burn surface area, sepsis and survival

ABSTRACT

Burn is a unique injury which is not only devastating for the patients but also puts a great burden on the society by consuming enormous health care resources. Despite improvements in burn wound care and treatment, understanding the role of pro-inflammatory, anti-inflamatory cytokines as well as the mechanisms responsible for the healing process remains to be clarified. Although leptin is regarded as a circulating hormone, it can exert direct effect on T cells and monocytes, causing the release of cytokines. It may induce angiogenesis or influence angiogenic factors. The aim of the present work is to determine serum levels of leptin, TNFalpha, IL-6, TGFalpha, and bFGF, PCT and CRP in a group of children with thermal burn and to determine the changes in these parameters in relation to the duration of hospital stay, the presence of infection and the total burn surface area. The study included 42 children with burns. They were 22 males and 20 females. Their ages ranged from 2 months to 7 years. The study also included 26 age matched controls. Beside full clinical assessment including assessment of total burn surface area [TBSA] and the presence or absence of sepsis, all the cases and controls had the following investigations done CBC, C-reactive protein [CRP], IL-6, TNFalpha, procalcitonin [PCT], serum leptin, basic fibroblast growth factor [bFGF], and transforming growth factor alpha [TGFalpha]. The fatality rate in this study was 28.6%. Burn cases as a whole showed significantly higher values of WBC, CRP, PCT, TNFalpha, IL-6, leptin, bFGF, and TGFalpha than controls. Cases with sepsis showed significantly higher values of WBC, CRP, PCT, TNFalpha and lL-6 than cases without sepsis. They showed significantly lower values of TGFalpha than cases without sepsis. Patients with larger TBSA [>30%] showed significantly higher levels of WBC, CRP, PCT, TNFalpha and lL-6 and leptin than cases with smaller TBSA. They showed significantly lower levels of bFGF, and TGFa than cases with smaller TBSA. Nonsurvivors showed significantly higher levels of WBC, CRP, PCT, TNFalpha and IL-6 than survivors. They showed significantly lower levels of leptin, bFGF, and TGFalpha than survivors. Correlation studies showed significant positive correlation between TBSA and each of IL-6, TNFalpha and leptin. Cytokines and leptin were increased in severe burn cases, cases associated with sepsis as well as in fatal cases. bFGF and TGFalpha levels were lower in severe cases. This may point to the impaired healing and to the poor prognosis in such cases. Recommendations: It is highly recommended to monitor immunologic parameters such as PCT and/or IL-6 for early detection of infectious complications following thermal injury. Leptin can be regarded as a novel treatment modality to diminish burn induced inflammation, to reduce post burn immune dysfunction and to enhance burn healing