Persistence of muscle catabolism after severe burn.
BACKGROUND
The hypermetabolic response to severe burn is characterized by muscle protein catabolism. Current opinion states that the hypermetabolic state resolves soon after complete wound closure. Clinically, we have witnessed that burned children appear to be hypermetabolic and catabolic long after full healing of their wounds. Our goal in this study was to determine scientifically if burn-associated hypermetabolism persists after full wound healing.


METHODS
To determine the duration of muscle catabolism and systemic hypermetabolism after severe burn in children, patients with > 40% total body surface area burns were enrolled in a prospective, longitudinal study; resting energy expenditure was measured by indirect calorimetry, muscle protein kinetics were determined by using stable isotopic methodology, and body composition was measured by dual-energy x-ray absorptiometry imaging. Data were collected at 6, 9, and 12 months after injury.


RESULTS
The mean total body surface area burned was 65% +/- 13%, and the mean age was 7.6 +/- 1. 5 years. Resting energy expenditure was elevated above the predicted age-matched levels from the Harris-Benedict equation and incrementally declined throughout the 12-month study. The net protein balance and lean mass reflected catabolic persistence at 6 and 9 months after severe burn. Between 9 and 12 months, protein breakdown decreased, net protein balance improved, and lean body mass increased.


CONCLUSIONS
In severely burned children, hypermetabolism and catabolism remain exaggerated for at least 9 months after injury. This suggests that therapeutic attempts to manipulate the catabolic and hypermetabolic response to severe injury should be continued long after injury.
Department of Surgery, The University of Texas Medical Branch, and the Shriners Hospitals for Children, Galveston 77550, USA.
D W
DW
Hart
S E
SE
Wolf
R
R
Mlcak
D L
DL
Chinkes
P I
PI
Ramzy
M K
MK
Obeng
A A
AA
Ferrando
R R
RR
Wolfe
D N
DN
Herndon
D015502:Absorptiometry, Photon; D000293:Adolescent; D001481:Basal Metabolism; D001823:Body Composition; D015992:Body Mass Index; D002056:Burns / Q000503:physiopathology*; D002153:Calorimetry, Indirect; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D008954:Models, Biological; D009124:Muscle Proteins / Q000378:metabolism*; D018482:Muscle, Skeletal / Q000503:physiopathology*; D010649:Phenylalanine / Q000378:metabolism; D013997:Time Factors; D014945:Wound Healing
D009124:Muscle Proteins; D010649:Phenylalanine