Rajan K Thakkar1, Zachary Diltz2, Joseph D Drews2, Krista K Wheeler3, Junxin Shi3, Racheal Devine4, Renata Fabia5, Mark Hall6. 1. The Ohio State University College of Medicine, Columbus, Ohio; Center for Clinical and Translational Research, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio; Department of Pediatric Surgery, Burn Center, Nationwide Children's Hospital, Columbus, Ohio; Center for Pediatric Trauma Research, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio. Electronic address: rajan.thakkar@nationwidechildrens.org. 2. The Ohio State University College of Medicine, Columbus, Ohio. 3. Center for Pediatric Trauma Research, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio. 4. Center for Clinical and Translational Research, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio. 5. The Ohio State University College of Medicine, Columbus, Ohio; Department of Pediatric Surgery, Burn Center, Nationwide Children's Hospital, Columbus, Ohio; Center for Pediatric Trauma Research, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio. 6. The Ohio State University College of Medicine, Columbus, Ohio; Center for Clinical and Translational Research, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio; Division of Critical Care Medicine, Nationwide Children's Hospital, Columbus, Ohio.
Abstract
BACKGROUND: Burns are a leading cause of morbidity in children, with infections representing the most common group of complications. Severe thermal injuries are associated with a profound inflammatory response, but the utility of laboratory values to predict infections in pediatric burn patients is poorly understood. MATERIALS AND METHODS: Our institutional burn database was queried for patients aged 18 y and younger with at least 10% total body surface area burns. Demographics, mechanism, laboratory results, and outcomes were extracted from the medical record. Patients were classified as having an abnormal or normal total white blood cell count, neutrophil percentage, and lymphocyte percentage using the first complete blood count drawn 72 or more hours postinjury. Outcomes were compared between groups. RESULTS: White blood cell data were available for 90 patients, 84 of whom had neutrophil and lymphocyte percentages. Abnormal lymphocyte percentage 72 h or more after burn injury was associated with a significant increase in infections (67.9% versus 32.3%, P = 0.003), length of stay (33.1 versus 18.8 d, P = 0.02), intensive care unit length of stay (13.1 versus 3.7 days, P = 0.01), and ventilator days (5.8 versus 2.3, P = 0.02). It was also an independent predictor of infection (odds ratio 7.2, 95% confidence interval 2.1-24.5). CONCLUSIONS: Abnormal lymphocyte percentage at or after 72 h after burn injury is associated with adverse outcomes, including increased infectious risk.
BACKGROUND: Burns are a leading cause of morbidity in children, with infections representing the most common group of complications. Severe thermal injuries are associated with a profound inflammatory response, but the utility of laboratory values to predict infections in pediatric burn patients is poorly understood. MATERIALS AND METHODS: Our institutional burn database was queried for patients aged 18 y and younger with at least 10% total body surface area burns. Demographics, mechanism, laboratory results, and outcomes were extracted from the medical record. Patients were classified as having an abnormal or normal total white blood cell count, neutrophil percentage, and lymphocyte percentage using the first complete blood count drawn 72 or more hours postinjury. Outcomes were compared between groups. RESULTS: White blood cell data were available for 90 patients, 84 of whom had neutrophil and lymphocyte percentages. Abnormal lymphocyte percentage 72 h or more after burn injury was associated with a significant increase in infections (67.9% versus 32.3%, P = 0.003), length of stay (33.1 versus 18.8 d, P = 0.02), intensive care unit length of stay (13.1 versus 3.7 days, P = 0.01), and ventilator days (5.8 versus 2.3, P = 0.02). It was also an independent predictor of infection (odds ratio 7.2, 95% confidence interval 2.1-24.5). CONCLUSIONS: Abnormal lymphocyte percentage at or after 72 h after burn injury is associated with adverse outcomes, including increased infectious risk.
Authors: Julia A Penatzer; Robin Alexander; Shan Simon; Amber Wolfe; Julie Breuer; Josey Hensley; Renata Fabia; Mark Hall; Rajan K Thakkar Journal: Front Immunol Date: 2022-07-26 Impact factor: 8.786