Association of postburn fatty acids and triglycerides with clinical outcome in severely burned children

Abstract

Context: Free fatty acids (FFAs) and triglycerides (TGs) are altered postburn, but whether these alterations are associated with postburn outcomes is not clear.

Objective: The aim of the present study was to analyze lipid metabolic profiles in pediatric burn patients and to correlate these profiles with patient outcomes and hospital courses.

Design and setting: We conducted a prospective cohort study at an academic pediatric hospital burn center.

Patients: Our study included 219 pediatric burn patients.

Main outcome measures: Patients were stratified according to their plasma TG and FFA levels. Main patient outcomes, such as postburn morbidity and mortality, and clinical metabolic markers were analyzed.

Results: All groups were similar in demographics and injury characteristics. Patients with elevated TGs had significantly worse clinical outcomes associated with increased acute-phase protein synthesis indicating augmented inflammation and hypermetabolism, whereas increased FFAs did not seem to profoundly alter postburn outcomes.

Conclusions: Elevated TGs, but not FFAs, postburn are associated with worsened organ function and clinical outcomes.

Trial registration: ClinicalTrials.gov NCT00675714.

Figures

Fig. 1.

FFAs and TGs throughout the hospital course. FFA and TG levels were consistently different among the groups for the whole observation period. Brackets annotate significances (P < 0.05) between the indicated groups and asterisks among the normal vs. FFA and TG groups.

Fig. 2.

Glucose metabolism shown by units of insulin administered and systemic daily average glucose levels. Normal patients received significantly (P < 0.05) more insulin up to d 23 postburn compared with FFA at similar average glucose levels.

Fig. 3.

Acute-phase proteins. CRP and C3c were significantly elevated in the TG group during the second phase postburn beginning d 17 compared with normal patients. RBP showed a significantly higher onset immediately after burn injury compared with normal. Brackets annotate significances (P < 0.05) between the groups.

Fig. 4.

Total protein and constitutive proteins α2-macroglobulin (Macro) and apolipoprotein B (ApoB). Serum levels of total protein increased over time in all groups at a similar rate. α2-Macroglobulin showed significantly (P < 0.05) higher levels in the FFA group throughout the whole study period compared with normal, whereas apolipoprotein B was elevated in the TG group. Brackets annotate significances (P < 0.05) between the groups.

Fig. 5.

Markers for renal and hepatic function. Blood urea nitrogen (BUN) and creatinine (CREA) displayed an impaired kidney function in the FFA and TG group between d 11 and 40. Liver function displayed by ALT and bilirubin (Bili) did not differ significantly between groups. Brackets annotate significances (P < 0.05) between the groups and asterisks among the normal vs. FFA and TG groups.

Fig. 6.

Liver size at admission and followed in 10-d intervals for the first 30 d expressed as percent predicted. Only the TG group showed a consistent significant rise over all time points up to d 30. Liver volume plateaued in the normal and FFA group. Asterisks indicate significance in the TG group.