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Persistent inflammation, immunosuppression, and catabolism syndrome and sepsis in pediatric burns
Michael D Santarelli1, Alvin D Jeffery2, Stephanie G Patterson1
1Department of Pediatrics, Vanderbilt University Medical Center, USA.
Insights
Persistent inflammation, immunosuppression, and catabolism syndrome (PIICS) affects 15% of pediatric burn patients and is linked to sepsis. Lymphopenia is a key indicator of this risk in children with burn injuries.
Area of Science:
- Pediatric critical care medicine
- Immunology
- Infectious disease
Background:
- Sepsis remains a major cause of morbidity and mortality in pediatric burn patients.
- Burn injuries induce an altered immune state, potentially leading to Persistent Inflammation, Immunosuppression, and Catabolism Syndrome (PIICS).
- The immunophenotype of PIICS in pediatric burn patients is not well-characterized.
Purpose of the Study:
- To determine the prevalence of PIICS and associated sepsis in children with burn injuries.
- To identify factors associated with the development of PIICS and sepsis.
- To investigate clinical and laboratory markers for PIICS and sepsis.
Main Methods:
- Retrospective analysis of pediatric burn injuries from 1997-2023.
- Utilized an institutional database with de-identified patient records.
- Analyzed a cohort of 287 pediatric burn patients.
Main Results:
- The prevalence of sepsis was 30% and PIICS was 15% in the cohort.
- Inhalation injury and total body surface area (TBSA) burned were associated with sepsis and PIICS.
- PIICS was independently associated with sepsis; lymphopenia showed the strongest association among clinical/laboratory criteria.
Conclusions:
- PIICS affects approximately 1 in 6 pediatric burn patients and is closely linked to sepsis development.
- Lymphopenia is a significant indicator for heightened concern regarding serious infections in pediatric burn patients.
- Early identification of PIICS and associated sepsis is crucial for improving outcomes in pediatric burn care.
Objective:
To determine the prevalence of persistent inflammation, immunosuppression, and catabolism syndrome (PIICS) and associated sepsis in children with burn injuries at a single, large institution over the past 25 years.
Background:
Despite advances in care, sepsis after burn injury continues to have a significant contribution to morbidity and mortality. This risk is compounded by an altered immune state after burn injury that can induce PIICS. While the presence of this dysregulated immunophenotype in pediatric burns is widely accepted, it remains poorly characterized.
Methods:
We performed a retrospective analysis of pediatric burn injuries utilizing an institutional database with de-identified patient records (1997-2023).
Results:
In the cohort of 287 patients, the overall prevalence of sepsis and PIICS among burn-injured children was 30 % and 15 %, respectively. The presence of inhalation injury and the total body surface area (TBSA) burned were both strongly associated with the development of sepsis and PIICS. While those with PIICS had more infections per patient compared to patients without PIICS, there was no difference in the pathogen profile between the two groups. Having PIICS itself was independently associated with the development of sepsis, and among the laboratory and clinical criteria, we found that lymphopenia had the strongest association.
Conclusion:
PIICS occurred in approximately 1 in 6 pediatric patients with burn injury. The development of PIICS is closely associated with the development of sepsis during hospitalization. Among the laboratory and clinical criteria, lymphopenia was most strongly associated with a septic event, suggesting that its presence should heighten concern about the development of serious infections in this vulnerable population.
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