A study on biomarkers, cytokines, and growth factors in children with burn injuries

Background. Burns are a unique injury which not only is devastating for the patients but also puts a great burden on society by consuming enormous health care resources. Despite improvements in burn wound care and treatment, understanding the role of pro-inflammatory and anti-inflammatory 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 a 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, tumour necrosis factor a (TNFa), interleukin-6 (IL-6), basic fibroblast growth factor (bFGF), procalcitonin (PCT), and C-reactive protein (CRP) in a group of children with thermal burns and to determine the changes in these parameters in relation to the duration of hospital stay, the presence of infection, and the total body surface area (TBSA) burned. Patients and methods. The study included 42 children with burns (22 males and 20 females; age range, 2 months to 7 years). The study also included 26 age-matched controls. Besides full clinical assessment, including assessment of TBSA burned and the presence or absence of sepsis, all the patients and controls had the following investigations performed: complete blood count, CRP, IL-6, TNFa, PCT, serum leptin, bFGF, and transforming growth factor a (TGFa). Results. The fatality rate in this study was 28.6%. Burn cases as a whole showed significantly higher values of white blood cells (WBC), CRP, PCT, TNFa, IL-6, leptin, bFGF, and TGFa than controls. Cases with sepsis showed significantly higher values of WBC, CRP, PCT, TNFa, and IL-6 than cases without sepsis. They showed significantly lower values of TGFa than cases without sepsis. Patients with larger TBSA (>30%) showed significantly higher levels of WBC, CRP, PCT, TNFa, IL-6, and leptin than cases with smaller TBSA. They showed significantly lower levels of bFGF and TGFa than patients with smaller TBSA. Non-survivors showed significantly higher levels of WBC, CRP, PCT, TNFa, and IL-6 than survivors. They showed significantly lower levels of leptin, bFGF, and TGFa than survivors. Correlation studies showed a significant positive correlation between TBSA and each of IL-6, TNFa, and leptin. Conclusions. Cytokines and leptin increased in severely burned patients, cases associated with sepsis, and in fatal cases, while bFGF and TGFa levels were lower in severe cases. This may point to impaired healing in such cases and to their poorer prognosis. Recommendations. It is highly recommended to monitor immunological 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, reduce post-burn immune dysfunction, and enhance burn healing.