title: Elevations in inflammatory cytokines are associated with poor outcomes in mechanically ventilated burn patients.
abstract: BACKGROUND
  The treatment of burn patients who undergo mechanical ventilation is complicated by many factors; patient outcomes and mortality could potentially be improved with predictive biomarkers. Severe burn provokes a systemic inflammatory response characterized by the release of a host of cytokines. Recent studies evaluated the prognostic value of temporal changes in cytokine levels in several patient populations, but few have compared differences in the cytokine profiles of survivors and nonsurvivors following severe burn. We previously compared high-frequency percussive ventilation and low-tidal-volume ventilation and found no difference in mortality or cytokine levels between the two treatments. Since it is unknown whether cytokine levels are predictive of mortality in these patients, we performed a post hoc analysis comparing cytokine levels in survivors and nonsurvivors.
  
  
  METHODS
  We evaluated plasma levels of several cytokines (interleukin 1β [IL-1β], IL-6, IL-8, granulocyte-macrophage colony-stimulating factor, and tumor necrosis factor α) for their prognostic biomarker potential related to mortality at 0, 3, and 7 days in survivors and nonsurvivors of burns.
  
  
  RESULTS
  While the majority of values for IL-1β, granulocyte-macrophage colony-stimulating factor, and tumor necrosis factor α fell below the limit of quantification, univariate analysis demonstrated higher plasma levels of IL-6 and IL-8 in nonsurvivors on Day 7. Logistic regression revealed that elevated plasma IL-8 was independently associated with an increased likelihood of the composite end point of death or ventilator-associated pneumonia with odds ratios of 7.9, 26, and 7.3 on Days 0, 3, and 7, respectively.
  
  
  CONCLUSIONS
  Early increases in plasma IL-8 are associated with a multifold increase in death or ventilator-associated pneumonia in mechanically ventilated burn patients.
  
  
  METHODS
  Prognostic/epidemiologic study, level IV; therapeutic study, level IV.
authors: From the US Air Force Center for Sustainment of Trauma and Readiness Skills (M.C.S.), University of Cincinnati Medical Center, Cincinnati, Ohio; US Army Institute of Surgical Research (M.P.R., L.C.C., J.K.A., R.Y.R., G.A.M., E.M.R., K.C.K.), JBSA Fort Sam Houston; University of Texas Health Science Center at San Antonio (L.C.C., K.C.K.), San Antonio; and University of Texas-Southwestern Medical Center (S.E.W.), Dallas, Texas; and Uniformed Services University of the Health Sciences (E.M.R., K.C.K.), Bethesda, Maryland.
authors: Mehdi C
authors: MC
authors: Shelhamer
authors: Matthew P
authors: MP
authors: Rowan
authors: Leopoldo C
authors: LC
authors: Cancio
authors: James K
authors: JK
authors: Aden
authors: Ryan Y
authors: RY
authors: Rhie
authors: Gerald A
authors: GA
authors: Merrill
authors: Steven E
authors: SE
authors: Wolf
authors: Evan M
authors: EM
authors: Renz
authors: Kevin K
authors: KK
authors: Chung
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood*; D002056:Burns / Q000097:blood* / Q000401:mortality*; D016207:Cytokines / Q000097:blood*; D005260:Female; D006801:Humans; D007118:Immunoassay; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D053717:Pneumonia, Ventilator-Associated / Q000097:blood; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000379:methods*; D016019:Survival Analysis
chemical_list: D015415:Biomarkers; D016207:Cytokines