Location: Arkansas Children's Nutrition CenterTitle: Predictors of muscle protein synthesis after severe pediatric burns Author
|Diaz, Eva - Arkansas Children's Nutrition Research Center (ACNC)|
|Herndon, David - University Of Texas Medical Branch|
|Lee, Jinhyang - University Of Seoul|
|Porter, Craig - University Of Texas Medical Branch|
|Cotter, Matthew - Arkansas Children's Nutrition Research Center (ACNC)|
|Suman, Oscar - University Of Texas Medical Branch|
|Sidossis, Labros - University Of Texas Medical Branch|
|Borsheim, Elisabet - Arkansas Children's Nutrition Research Center (ACNC)|
Submitted to: Journal of Trauma and Acute Care Surgery
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 1/12/2015
Publication Date: 4/1/2015
Citation: Diaz, E.C., Herndon, D.N., Lee, J., Porter, C., Cotter, M., Suman, O.E., Sidossis, L.S., Borsheim, E. 2015. Predictors of muscle protein synthesis after severe pediatric burns. Journal of Trauma and Acute Care Surgery. 78(4):816-822.
Interpretive Summary: We set out to determine skeletal muscle protein fractional synthesis rate (FSR) in pediatric patients with large burns at several time points, extending out to two years post-injury. Our hypothesis was that much like other aspects of the stress response to burn injury, elevated skeletal muscle FSR would persist long after discharge from hospital. The second aim was to identify predictors of skeletal muscle FSR in severely burned children. The principle findings of this study were that skeletal muscle FSR is chronically elevated for over a year post-injury in severely burned children. In addition, age, sex, % TBSA burn, % third degree TBSA burn, and simultaneous inhalation injury were also found to have significant impact on skeletal muscle FSR following severe burn injury.
Technical Abstract: Objectives: Following a major burn, muscle protein synthesis rate increases but in most patients, this response is not sufficient to compensate the also elevated protein breakdown. Given the long-term nature of the pathophysiologic response to burn injury, we hypothesized that skeletal muscle protein synthesis is chronically elevated in severely burned children. The objectives of this descriptive study were to characterize protein synthesis rate in skeletal muscle of burn children over a period of 24 months post-injury, and identify predictors that influence this response. Study design: 87 children with =40% total body surface area (TBSA) burn were included. Patients participated in stable isotope infusion studies at 1, 2 and 4 weeks post-burn and at 6, 12 and 24 months post-injury in order to determine skeletal muscle fractional synthesis rate (FSR). Generalized estimating equations with log link normal distribution were applied to account for clustering of patients and control for patient characteristics. Results: Patients (8±6 yrs.) had large (59±14 % TBSA), deep (47±21% 3rd degree) burns. Muscle FSR was elevated up to 12 months post-burn. FSR was negatively associated with male sex, age, %TBSA burned, % 3rd degree TBSA burned and time. Inhalation injury was positively associated with FSR. Conclusions: Muscle protein FSR is elevated for over a year after injury. Muscle FSR is influenced by sex, age, %TBSA burn, % third degree burn, and smoke inhalation injury. This may explain the divergence in net protein balance and lean body mass in different populations of burn victims.