Biomarkers for the Early Diagnosis of Sepsis in Burns

Abstract

The aim of this study was to evaluate the diagnostic performance of all biomarkers studied to date for the early diagnosis of sepsis in hospitalized patients with burns. Background: Early clinical diagnosis of sepsis in burns patients is notoriously difficult due to the hypermetabolic nature of thermal injury. A considerable variety of biomarkers have been proposed as potentially useful adjuncts to assist with making a timely and accurate diagnosis. Methods: We searched Medline, Embase, Cochrane CENTRAL, Biosis Previews, Web of Science, and Medline In-Process to February 2020. We included diagnostic studies involving burns patients that assessed biomarkers against a reference sepsis definition of positive blood cultures or a combination of microbiologically proven infection with systemic inflammation and/or organ dysfunction. Pooled measures of diagnostic accuracy were derived for each biomarker using bivariate random-effects meta-analysis. Results: We included 28 studies evaluating 57 different biomarkers and incorporating 1517 participants. Procalcitonin was moderately sensitive (73%) and specific (75%) for sepsis in patients with burns. C-reactive protein was highly sensitive (86%) but poorly specific (54%). White blood cell count had poor sensitivity (47%) and moderate specificity (65%). All other biomarkers had insufficient studies to include in a meta-analysis, however brain natriuretic peptide, stroke volume index, tumor necrosis factor (TNF)-alpha, and cell-free DNA (on day 14 post-injury) showed the most promise in single studies. There was moderate to significant heterogeneity reflecting different study populations, sepsis definitions and test thresholds. Conclusions:The most widely studied biomarkers are poorly predictive for sepsis in burns patients. Brain natriuretic peptide, stroke volume index, TNFalpha, and cell-free DNA showed promise in single studies and should be further evaluated. A standardized approach to the evaluation of diagnostic markers (including time of sampling, cut-offs, and outcomes) would be useful.

The Complexity of the Post-Burn Immune Response: An Overview of the Associated Local and Systemic Complications

“…The higher the PCT concentration, the more likely systemic infection and sepsis would be [116]. However, it is very difficult to accurately diagnose sepsis based on biomarkers only [117]; even positive blood cultures in sepsis cohorts are found in around 40% in prospective studies [118,119]. Moreover, sepsis diagnosis in burn patients is based on the clinical situation, i.e., increased fluid requirements, low platelet counts and declining pulmonary and/or renal function.…”

Burns: Classification, Pathophysiology, and Treatment: A Review

“…Given that sepsis plays a significant role in increasing mortality associated with burns and hypermetabolic response, every effort should be made to control its rate by taking appropriate measures. These will also help prevent infection in patients [ 60 ].…”

“…Prevention and early recognition of sepsis is a key element in the critical care of the burn patient [ 60 ]. Prevention strategies include topical antimicrobial dressings, early excision and grafting, as well as nutritional support.…”

“…In patients with burns, procalcitonin was moderately sensitive (73%) and specific (75%) for sepsis, white blood cell count had poor sensitivity (47%) and moderate specificity (65%), and C-reactive protein was highly sensitive (86%) but poorly specific (54%). Other biomarkers such as stroke volume index, brain natriuretic peptide, TNF-alpha, and cell-free DNA measured on day 14 post injury showed the most promise [ 60 ].…”

Immunological and Prognostic Role of Hub Genes Defined Gene Signature in Septic Cardiomyopathy

“…As many as 20-65% of patients with sepsis have myocardial dysfunction, and more than 10% of sepsis develop into septic cardiomyopathy eventually 10 . Although researchers have shown that early-stage myocardial dysfunction can be reversed 11,12 , it is still di cult to intervene in advance due to vague pathophysiological processes and a lack of accurate biomarkers [13][14][15] .…”