title: Early pulmonary immune hyporesponsiveness is associated with mortality after burn and smoke inhalation injury.
abstract: This prospective study aims to address mortality in the context of the early pulmonary immune response to burn and inhalation injury. The authors collected bronchoalveolar lavage fluid from 60 burn patients within 14 hours of their injury when smoke inhalation was suspected. Clinical and laboratory parameters and immune mediator profiles were compared with patient outcomes. Patients who succumbed to their injuries were older (P = .005), had a larger % TBSA burn (P < .001), and required greater 24-hour resuscitative fluids (P = .002). Nonsurvivors had lower bronchoalveolar lavage fluid concentrations of numerous immunomodulators, including C5a, interleukin (IL)-1β, IL-1RA, IL-8, IL-10, and IL-13 (P < .05 for all). Comparing only those with the highest Baux scores to account for the effects of age and % TBSA burn on mortality, nonsurvivors also had reduced levels of IL-2, IL-4, granulocyte colony-stimulating factor, interferon-γ, macrophage inflammatory protein-1β, and tumor necrosis factor-α (P < .05 for all). The apparent pulmonary immune hyporesponsiveness in those who died was confirmed by in vitro culture, which revealed that pulmonary leukocytes from nonsurvivors had a blunted production of numerous immune mediators. This study demonstrates that the early pulmonary immune response to burn and smoke inhalation may be attenuated in patients who succumb to their injuries.
authors: Burn and Shock Trauma Institute, Department of Surgery, Loyola University Medical Center, Maywood, Illinois 60153, USA.
authors: Christopher S
authors: CS
authors: Davis
authors: Joslyn M
authors: JM
authors: Albright
authors: Stewart R
authors: SR
authors: Carter
authors: Luis
authors: L
authors: Ramirez
authors: Hajwa
authors: H
authors: Kim
authors: Richard L
authors: RL
authors: Gamelli
authors: Elizabeth J
authors: EJ
authors: Kovacs
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000032:analysis; D001992:Bronchoalveolar Lavage Fluid / Q000276:immunology*; D001999:Bronchoscopy; D002056:Burns / Q000175:diagnosis / Q000276:immunology* / Q000401:mortality*; D002423:Cause of Death; D015331:Cohort Studies; D016001:Confidence Intervals; D005260:Female; D006801:Humans; D007108:Immune Tolerance / Q000276:immunology*; D015601:Injury Severity Score; D007378:Interleukins / Q000378:metabolism; D016015:Logistic Models; D008168:Lung / Q000276:immunology* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011379:Prognosis; D018570:Risk Assessment; D015208:Smoke Inhalation Injury / Q000175:diagnosis / Q000276:immunology* / Q000401:mortality*; D015996:Survival Rate; D013997:Time Factors
chemical_list: D015415:Biomarkers; D007378:Interleukins