A new marker of sepsis post burn injury?

Paratz, Jennifer D., Lipman, Jeffrey, Boots, Robert J., Muller, Michael J. and Paterson, David L. (2014) A new marker of sepsis post burn injury?. Critical Care Medicine, 42 9: 2029-2036. doi:10.1097/CCM.0000000000000400

Author Paratz, Jennifer D.
Lipman, Jeffrey
Boots, Robert J.
Muller, Michael J.
Paterson, David L.
Title A new marker of sepsis post burn injury?
Journal name Critical Care Medicine   Check publisher's open access policy
ISSN 0090-3493
Publication date 2014-01-01
Year available 2014
Sub-type Article (original research)
DOI 10.1097/CCM.0000000000000400
Volume 42
Issue 9
Start page 2029
End page 2036
Total pages 8
Place of publication Baltimore, MD United States
Publisher Lippincott Williams and Wilkins
Language eng
Subject 2706 Critical Care and Intensive Care Medicine
Abstract OBJECTIVES:: Accurate diagnosis of sepsis is difficult in patients post burn due to the large inflammatory response produced by the major insult. We aimed to estimate the values of serum N-terminal pro-B-type natriuretic peptide and procalcitonin and the changes in hemodynamic variables as markers of sepsis in critically ill burn patients. DESIGN:: Prospective, observational study. SETTING:: A quaternary-level university-affiliated ICU. PATIENTS:: Fifty-four patients with burns to total body surface area of greater than or equal to 15%, intubated with no previous cardiovascular comorbidities, were enrolled. INTERVENTIONS:: At admission, a FloTrac/Vigileo system was attached and daily blood samples taken from the arterial catheter. Infection surveillance was carried out daily with patients classified as septic/nonseptic according to American Burns Consensus criteria. MEASUREMENTS AND MAIN RESULTS:: N-terminal pro-B-type natriuretic peptide, procalcitonin, and waveform analysis of changes in stroke volume index and systemic vascular resistance index were measured within the first 24 hours after burn and daily thereafter for the length of the ICU stay or until their first episode of sepsis. Prevalences of stroke volume variation less than 12% (normovolemia) with hypotension (systolic blood pressure < 90mm Hg) were recorded. Patients with sepsis differed significantly from "no sepsis" for N-terminal pro-B-type natriuretic peptide, systemic vascular resistance index, and stroke volume index on days 3-7. Procalcitonin did not differ between sepsis and "no sepsis" except for day 3. Area under the receiver operating characteristic curves showed excellent discriminative power for B-type natriuretic peptide (p = 0.001; 95% CI, 0.99-1.00), systemic vascular resistance index (p < 0.001; 95% CI, 0.97-0.99), and stroke volume index (p < 0.01; 95% CI, 0.96-0.99) in predicting sepsis but not for procalcitonin (not significant; 95% CI, 0.29-0.46). A chi-square crosstab found that there was no relationship between hypotension with normovolemia (stroke volume variation < 12%) and sepsis. CONCLUSIONS:: Serum N-terminal pro-B-type natriuretic peptide levels and certain hemodynamic changes can be used as an early indicator of sepsis in patients with burn injury. Procalcitonin did not assist in the early diagnosis of sepsis.
Keyword Brain
Natriuretic peptide
Sepsis syndrome
Systemic inflammatory response syndrome
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: UQ Centre for Clinical Research Publications
Official 2015 Collection
School of Medicine Publications
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Citation counts: TR Web of Science Citation Count  Cited 15 times in Thomson Reuters Web of Science Article | Citations
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