Open Access

The struggle to differentiate inflammation from infection in severely burned patients: time to send better biomarkers into the arena?

Critical Care201620:13

https://doi.org/10.1186/s13054-016-1194-8

Published: 20 January 2016

The original article was published in Critical Care 2015 19:243

We read with great interest the highly educational review by Rowan et al. on wound healing and treatment of burn patients [1]. As discussed in detail by the authors, burn injury is inextricably linked with some states of inflammation. Acute-phase activation of crucial immune processes is imperative for survival and initiation of wound healing, otherwise inflammation may become detrimental when caused by intercurrent infection or diseases such as sepsis or pancreatitis. The bedside clinician is often faced with the problem of differentiating between burn- or infection-related inflammation. For this purpose, poorly specific markers such as C-reactive protein (CRP) and white blood cell (WBC) count are still frequently used. In recent years, however, procalcitonin (PCT) has emerged as a more optimal biomarker for diagnosis and prognosis of infection in severely burned patients [2]. Monitoring PCT levels over time could also steer antibiotic treatment, minimize antibiotic overuse, and reduce the risk of developing multi-drug resistant bacterial infections. Yet, due to limited access and cost, PCT has not supplanted CRP in many burn centers. Moreover, recent prospective studies have challenged the utility of the PCT assay and proposed other potentially valid biomarkers for detecting sepsis in burn injury. Paratz et al. [3] found that plasma levels of the N-terminal fragment of the pro-hormone brain-type natriuretic peptide better predicted early sepsis than PCT. Cakır Madenci et al. [4] reported that soluble CD14 subtype (presepsin) had similar diagnostic and prognostic accuracy as CRP and PCT. However, sepsis patients had significantly different presepsin, CRP, and WBC count but not PCT levels on the first day of sepsis compared with previous days. This preliminary experience needs confirmation in a larger patient cohort. In addition, the clinical usefulness of any novel biomarker must be assessed in specific subgroups (e.g., patients undergoing extracorporeal treatment) [5].

Notes

Abbreviations

CRP: 

C-reactive protein

PCT: 

procalcitonin

WBC: 

white blood cell

Declarations

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Authors’ Affiliations

(1)
ICU Department, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel

References

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Copyright

© Honore and Spapen. 2016

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