Altered levels of pro-inflammatory markers secondary to trauma or surgery present a major problem to physicians in being prone to interfere with the clinical identification of infectious events.
Patients admitted to Zurich Burn Center between May 2015 and October 2018 with burns ≥10% total body surface area (TBSA) and without infection. Longitudinal analysis of the time course of PSP and routine inflammatory biomarkers [procalcitonin (PCT), C-reactive protein (CRP) and white blood cells (WBC)] over two days after (a) trauma with initial debridement and (b) subsequent burn surgeries was performed. The influence of TBSA, abbreviated burn severity index (ABSI), age and length of operation was investigated using a linear mixed effect regression model.
Sixty-six patients (15 female) were included with a mean age of 45.5 ± 18.3 years, median TBSA of 22% (IQR 17) and mean ABSI score 6.8 ± 2.7. PSP was the only biomarker that showed no association with any of the baseline characteristics. Additionally, PSP serum levels did not change over time neither after the burn trauma (p = 0.832) nor after secondary procedures (p = 0.113), while PCT levels increased significantly after the trauma (p < 0.001). Similarly, CRP serum levels were elevated significantly after both trauma and surgery (p < 0.001), whereas WBC values demonstrated a significant decline after the trauma (p < 0.001).
Established biomarkers (WBC, CRP and PCT) demonstrate decisive alterations after tissue destruction caused by burn injuries and subsequent surgical interventions. The robustness of PSP serum levels toward these inflammatory insults is a quality criterion for an upcoming sepsis biomarker.
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This study was supported by a grant from the Gottfried and Julia Bangerter-Rhyner Foundation. The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript.
Conflict of interest
Rolf Graf is inventor of an assay covered by Patent No: EP 2185937 B2 "Method for Assaying sepsis in Humans", which is owned by the University of Zurich (Zurich, Switzerland). This does not alter the authors' adherence to all the policies on sharing data and materials.
Ethics approval was obtained from the Ethics committee of the University of Zurich, Switzerland on April 20th 2015 (KEK-ZH-No: 2014-0631).
Informed consent was obtained from all individual participants included in the study.
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Klein, H.J., Buehler, P.K., Niggemann, P. et al. Expression of Pancreatic Stone Protein is Unaffected by Trauma and Subsequent Surgery in Burn Patients. World J Surg 44, 3000–3009 (2020). https://doi.org/10.1007/s00268-020-05589-w