title: Extent and magnitude of catecholamine surge in pediatric burned patients.
abstract: Increased catecholamine (CA) levels after severe burn are associated with stress, inflammation, hypermetabolism, and impaired immune function. The CA secretion profiles in burned patients are not well described. Mechanisms, duration, and extent of CA surge are unknown. The purpose of this large unicenter study was to evaluate the extent and magnitude of CA surge after severe burn in pediatric patients. Patients admitted between 1996 and 2008 were enrolled in this study. Twenty-four-hour urine collections were performed during acute hospitalization and up to 2 years postburn. Results from the samples collected from 12 normal, healthy volunteers were compared with the data from the burned patients. Relevant demographic and clinical information was obtained from medical records. Student t-test and one-way ANOVA were used to analyze the data where appropriate. Significance was accepted at P < 0.05. Four hundred thirteen patients were enrolled in this study; 17 patients died during acute hospitalization. Burn caused a marked stress and inflammatory response, indicated by massive tachycardia and elevated proinflammatory cytokines. In burned patients, CA levels are consistently and significantly modulated after burn when compared with the levels in normal, healthy volunteers. Catecholamine levels were significantly higher in boys compared with girls, correlated with burn size in burns greater than 40%, and were increased in older children. There were differences over time in survivors versus nonsurvivors, with CA levels significantly higher in nonsurvivors at two time points. Inflammatory cytokines show a similar profile during the study period. Our study gives clinicians a useful insight into the extent and magnitude of CA elevation to better design treatment strategies.
authors.affiliation: Shriners Hospitals for Children, Department of Surgery, University Texas Medical Branch Galveston, Texas 77550, USA.
authors.forename: Gabriela A
authors.initials: GA
authors.lastname: Kulp
authors.forename: David N
authors.initials: DN
authors.lastname: Herndon
authors.forename: Jong O
authors.initials: JO
authors.lastname: Lee
authors.forename: Oscar E
authors.initials: OE
authors.lastname: Suman
authors.forename: Marc G
authors.initials: MG
authors.lastname: Jeschke
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002056:Burns / Q000473:pathology / Q000503:physiopathology* / Q000652:urine; D002395:Catecholamines / Q000652:urine*; D002648:Child; D002675:Child, Preschool; D016207:Cytokines / Q000652:urine; D004298:Dopamine / Q000652:urine; D004837:Epinephrine / Q000652:urine; D005260:Female; D016179:Granulocyte Colony-Stimulating Factor / Q000652:urine; D006339:Heart Rate; D006801:Humans; D007249:Inflammation / Q000503:physiopathology / Q000652:urine; D015850:Interleukin-6 / Q000652:urine; D016209:Interleukin-8 / Q000652:urine; D008297:Male; D009638:Norepinephrine / Q000652:urine; D012737:Sex Factors; D014409:Tumor Necrosis Factor-alpha / Q000652:urine
chemical_list: D002395:Catecholamines; D016207:Cytokines; D015850:Interleukin-6; D016209:Interleukin-8; D014409:Tumor Necrosis Factor-alpha; D016179:Granulocyte Colony-Stimulating Factor; D004298:Dopamine; D009638:Norepinephrine; D004837:Epinephrine
references.citation: Novartis Found Symp. 2007;280:238-48; discussion 248-51
references.pmid: 17380798
references.citation: Clin Endocrinol (Oxf). 1998 Sep;49(3):335-41
references.pmid: 9861325
references.citation: Shock. 2007 May;27(5):461-5
references.pmid: 17438449
references.citation: Int J Biochem Cell Biol. 2005 Oct;37(10):1948-61
references.pmid: 16109499
references.citation: Burns. 2004 Jun;30(4):317-21
references.pmid: 15145188
references.citation: J Clin Endocrinol Metab. 2009 May;94(5):1656-64
references.pmid: 19240154
references.citation: Physiol Rev. 2009 Apr;89(2):535-606
references.pmid: 19342614
references.citation: J Trauma. 1998 Dec;45(6):1074-8
references.pmid: 9867051
references.citation: Shock. 2002 Jul;18(1):38-45
references.pmid: 12095132
references.citation: Burns. 1997 Jun;23(4):291-4
references.pmid: 9248636
references.citation: Prog Brain Res. 2008;167:229-37
references.pmid: 18037018
references.citation: J Burn Care Rehabil. 2003 Sep-Oct;24(5):297-305
references.pmid: 14501398
references.citation: Shock. 2008 Nov;30(5):503-7
references.pmid: 18391855
references.citation: Cytokine. 2005 Mar 7;29(5):208-14
references.pmid: 15760677
references.citation: Burns. 2006 Aug;32(5):554-62
references.pmid: 16765521
references.citation: Crit Care Med. 2007 Sep;35(9 Suppl):S616-20
references.pmid: 17713418
references.citation: Endocr Regul. 2007 Jun;41(2-3):61-73
references.pmid: 18257649
references.citation: J Trauma. 2010 Jan;68(1):193-7
references.pmid: 20065775
references.citation: Nihon Geka Gakkai Zasshi. 1998 Jan;99(1):2-7
references.pmid: 9547740
references.citation: Expert Opin Pharmacother. 2003 Mar;4(3):369-84
references.pmid: 12614189
references.citation: N Engl J Med. 2001 Oct 25;345(17):1223-9
references.pmid: 11680441
references.citation: Anesthesiology. 2000 Aug;93(2):351-8
references.pmid: 10910481
references.citation: J Trauma. 2006 Apr;60(4):736-44
references.pmid: 16612292
references.citation: Am J Physiol Endocrinol Metab. 2008 Jan;294(1):E1-9
references.pmid: 17957035
references.citation: Shock. 2007 Aug;28(2):172-7
references.pmid: 17529902