Early pulmonary immune hyporesponsiveness is associated with mortality after burn and smoke inhalation injury. Journal Article


Authors: Davis, C. S.; Albright, J. M.; Carter, S. R.; Ramirez, L; Kim, H.; Gamelli, R. L.; Kovacs, E. J.
Article Title: Early pulmonary immune hyporesponsiveness is associated with mortality after burn and smoke inhalation injury.
Abstract: This prospective study aims to address mortality in the context of the early pulmonary immune response to burn and inhalation injury. The authors collected bronchoalveolar lavage fluid from 60 burn patients within 14 hours of their injury when smoke inhalation was suspected. Clinical and laboratory parameters and immune mediator profiles were compared with patient outcomes. Patients who succumbed to their injuries were older (P = .005), had a larger % TBSA burn (P .001), and required greater 24-hour resuscitative fluids (P = .002). Nonsurvivors had lower bronchoalveolar lavage fluid concentrations of numerous immunomodulators, including C5a, interleukin (IL)-1beta, IL-1RA, IL-8, IL-10, and IL-13 (P .05 for all). Comparing only those with the highest Baux scores to account for the effects of age and % TBSA burn on mortality, nonsurvivors also had reduced levels of IL-2, IL-4, granulocyte colony-stimulating factor, interferon-gamma, macrophage inflammatory protein-1beta, and tumor necrosis factor-alpha (P .05 for all). The apparent pulmonary immune hyporesponsiveness in those who died was confirmed by in vitro culture, which revealed that pulmonary leukocytes from nonsurvivors had a blunted production of numerous immune mediators. This study demonstrates that the early pulmonary immune response to burn and smoke inhalation may be attenuated in patients who succumb to their injuries.
Keywords: Adult; Aged; Aged, 80 and over; Female; Humans; Middle Aged; Surgery; Bronchoalveolar Lavage Fluid; Injury Severity Score; Male; Smoke Inhalation Injury; Survival Rate; Biological Markers; Burns; Cohort Studies; Prognosis; Risk Assessment; Time Factors; Age Factors; Confidence Intervals; Odds Ratio; Bronchoscopy; Cause of Death; Immune Tolerance; Interleukins; Logistic Models; Lung
Journal Title: Journal of Burn Care Research
Volume: 33
Issue: 1
ISSN: 1559-0488
Publisher: Unknown  
Journal Place: United States
Date Published: 2012
Start Page: 26
End Page: 35
Language: English
DOI/URL:
Notes: ID: 12312; Record Owner: From MEDLINE, a database of the U.S. National Library of Medicine.; Status: MEDLINE; Publishing Model: Journal available in: Print Citation processed from: Internet; NLM Journal Code: 101262774; Other ID: Source: NLM. NIHMS328383 [Available on 01/01/13] Source: NLM. PMC3253958 [Available on 01/01/13]; CAS Registry/EC Number/Name of Substance: 0 (Biological Markers). 0 (Interleukins).; Grant Number: P30 AA019373 (United States NIAAA NIH HHS), P30 AA019373-01 (United States NIAAA NIH HHS), P30 AA019373-02 (United States NIAAA NIH HHS), R01 AA012034 (United States NIAAA NIH HHS), R01 AA012034 (United States NIAAA NIH HHS), R01 AA012034-10 (United States NIAAA NIH HHS), R01 AA012034-11 (United States NIAAA NIH HHS), R01 AA012034-12 (United States NIAAA NIH HHS), T32 AA013527 (United States NIAAA NIH HHS), T32 AA013527-07 (United States NIAAA NIH HHS), T32 AA013527-08 (United States NIAAA NIH HHS), T32 AA013527-09 (United States NIAAA NIH HHS), T32 GM008750 (United States NIGMS NIH HHS); Entry Date: 20120517