Burns, endothelial dysfunction, and oxidative stress: the role of antioxidants

Background. Burns cause a systemic inflammatory response, endothelial dysfunction, and increased microvascular permeability which results in oedema being formed; these effects are probably the result of a complex interplay between the direct effects of heat on the microcirculation and the action of chemical mediators, including reactive oxygen species. The use of antioxidants can reduce these changes, which are considered a promised step in burns management. Patients and methods. Forty-eight burn patients of either sex and with varying burns percentages were involved in the study. They were each allocated to one of four groups: A, B, C, and D, each group composed of 12 patients. Groups B, C, and D were treated with antioxidants: allopurinol, melatonin, and N-acetylcysteine respectively, while group A was treated according to normal hospital policy, without antioxidants; 12 healthy subjects (group E) served as a control group for comparison. In each group, serum malondialdehyde and serum glutathione levels were measured and liver and kidney function tests were performed, as well as microalbuminuria tests, using standard methods. Results. The administration of antioxidants to burns patients produced significant improvements in the parameters studied compared to group A parameters (no antioxidant given). Conclusion. This study clearly demonstrates the role of reactive oxygen species in endothelial dysfunction occurring in burn patients and the beneficial effect of antioxidants in reducing it, as shown by the reduced microalbuminuria and reduced resuscitation fluid in antioxidant-treated burn patients; the study also supports newly emerging evidence regarding the use of microalbuminuria as an indicator for endothelial dysfunction in burn patients.