Changes in serum tumour necrosis factor-alpha in burned patients

Dynamic tumour necrosis factor-alpha (TNF-alpha) changes in serial serum samples of 10 burned patients were analysed in this study. The total body surface areas (TBSA) of the burn injury were from 30 to 85 per cent. Among these 10 patients, five recovered and another five died with proved sepsis. On admission which was about 5-13 h postburn, eight of the 10 patients showed their serum TNF-alpha levels to be higher than the mean serum TNF-alpha value of five healthy laboratory personnel. Furthermore, an initial peak serum TNF-alpha response which could be detected within 2.5 days after burn injury has also been observed. However, significant differences in both the serum TNF-alpha values on admission, as well as the first peak serum TNF-alpha levels, were not found (P > 0.05) between patients with TBSA of greater or less than 50 per cent and patients who survived or died from burn injury. In the survivors, serum TNF-alpha stayed at low levels, while it increased markedly in four of the five non-survivors with proven sepsis starting at about 1 week postburn. A significant difference in the maximum serum TNF-alpha levels (P < 0.05) was detected between patients who recovered and died from the thermal injury. In conclusion, great increases in serum TNF-alpha levels have been detected in burned patients with the occurrence of bacterial infection postburn. It is suggested that strategies for the inhibition of TNF-alpha production or in the neutralization of TNF-alpha activity should also be considered in the better treatment of burned patients.