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Article
Prediction of Multiple Infections After Severe Burn Trauma: a Prospective Cohort Study
Annals of Surgery (2014)
  • Patrick Flaherty
Abstract
OBJECTIVE:
To develop predictive models for early triage of burn patients based on hypersusceptibility to repeated infections.
BACKGROUND:
Infection remains a major cause of mortality and morbidity after severe trauma, demanding new strategies to combat infections. Models for infection prediction are lacking.
METHODS:
Secondary analysis of 459 burn patients (≥16 years old) with 20% or more total body surface area burns recruited from 6 US burn centers. We compared blood transcriptomes with a 180-hour cutoff on the injury-to-transcriptome interval of 47 patients (≤1 infection episode) to those of 66 hypersusceptible patients [multiple (≥2) infection episodes (MIE)]. We used LASSO regression to select biomarkers and multivariate logistic regression to built models, accuracy of which were assessed by area under receiver operating characteristic curve (AUROC) and cross-validation.
RESULTS:
Three predictive models were developed using covariates of (1) clinical characteristics; (2) expression profiles of 14 genomic probes; (3) combining (1) and (2). The genomic and clinical models were highly predictive of MIE status [AUROCGenomic = 0.946 (95% CI: 0.906-0.986); AUROCClinical = 0.864 (CI: 0.794-0.933); AUROCGenomic/AUROCClinical P = 0.044]. Combined model has an increased AUROCCombined of 0.967 (CI: 0.940-0.993) compared with the individual models (AUROCCombined/AUROCClinical P = 0.0069). Hypersusceptible patients show early alterations in immune-related signaling pathways, epigenetic modulation, and chromatin remodeling.
CONCLUSIONS:
Early triage of burn patients more susceptible to infections can be made using clinical characteristics and/or genomic signatures. Genomic signature suggests new insights into the pathophysiology of hypersusceptibility to infection may lead to novel potential therapeutic or prophylactic targets.
Publication Date
Spring June 19, 2014
DOI
10.1097/SLA.0000000000000759
Citation Information
Patrick Flaherty. "Prediction of Multiple Infections After Severe Burn Trauma: a Prospective Cohort Study" Annals of Surgery Vol. 261 Iss. 4 (2014) p. 781 - 792
Available at: http://works.bepress.com/patrick-flaherty/11/