Predicting fatal sepsis in burn patients

Area of Science:

• Immunology
• Burn Injury Research
• Critical Care Medicine

Background:

• Severe thermal injury (burns) often leads to decreased immunocompetence.
• Assessing immune function post-burn is crucial for predicting patient outcomes, particularly sepsis development.

Purpose of the Study:

• To evaluate lymphocyte transformation responses to phytohemagglutinin (PHA) and Concanavalin A (Con A) in burn patients.
• To determine if changes in mitogen response can predict sepsis development and mortality after thermal injury.

Main Methods:

• Seventeen patients with moderate to severe thermal injury (>25% BSA) were studied.
• Lymphocyte transformation assays using PHA and Con A were performed over time, with patients serving as their own controls.
• Patients were categorized into groups based on sepsis development and clinical outcomes.

Main Results:

• Patients who developed severe sepsis (Group I) showed significantly decreased PHA responses (12% of normal), preceding clinical sepsis by 2-4 days.
• Patients with mild infections (Group II) exhibited augmented PHA responses (+243%) around 7-10 days post-injury.
• Sepsis-free patients (Group III) had minimal changes in PHA responses (+30%). Con A responses generally mirrored PHA trends.

Conclusions:

• Decreased PHA-induced lymphocyte proliferation after severe thermal injury is a potential early indicator of an inability to combat sepsis.
• Monitoring mitogen-induced lymphocyte responses may aid in identifying burn patients at high risk for severe sepsis and mortality.