Pancreatic Stone Protein in Burns: Clinical Value of Bedside Testing-A Prospective Pilot Study

Background: Early detection of severe infections in burn patients is difficult due to confounding sterile inflammation. Previous research has shown that Pancreatic Stone Protein (PSP) is less affected by trauma and surgery. Therefore, this study investigated whether longitudinal PSP trends can distinguish sterile post-burn inflammation from clinically relevant infections and indicate response to antimicrobial therapy. Methods: This prospective pilot cohort study included 10 consecutive adult patients with moderate to severe burn injuries admitted to a specialized burn intensive care unit. PSP levels were measured using bedside testing (abioSCOPE^®) daily over a 14-day observation period. Clinical parameters, burn severity as assessed by the Abbreviated Burn Severity Index (ABSI), and the occurrence of severe infectious complications, including pneumonia and bacteremia, were systematically recorded. PSP measurements were not used to guide clinical decision-making. Results: Patients who developed severe infectious complications (pneumonia and/or bacteremia; mean ABSI 8.5) showed a consistent and characteristic increase in PSP levels (>350 ng/mL) over time, with elevations preceding the clinical diagnosis of infection (24-120 h). In contrast, patients without pneumonia or bacteremia (mean ABSI 6) exhibited low and stable PSP (<150 ng/mL) concentrations throughout the observation period, despite the presence of burn-related injury and the expected sterile inflammatory response. Conclusions: In this exploratory cohort study distinct PSP trajectory patterns, with persistently low levels in non-infected patients and rising levels preceding clinically diagnosed infection in several cases, were observed. These preliminary findings suggest that longitudinal PSP monitoring may provide potential utility for infection surveillance in burn ICU patients. However, due to the exploratory design and very limited sample size, the findings should be interpreted cautiously and require validation in larger prospective multicenter studies before conclusions regarding clinical decision-making or patient outcomes can be drawn.