Determinants of skeletal muscle protein turnover following severe burn trauma in children. Issue 3 (June 2019)

• Record Type: Journal Article
• Authors: Malagaris, Ioannis; Herndon, David N.; Polychronopoulou, Efstathia; Rontoyanni, Victoria G.; Andersen, Clark R.; Suman, Oscar E.; Porter, Craig; Sidossis, Labros S.
• Is Part Of: Clinical nutrition. Volume 38:Issue 3(2019)
• Page Start: 1348
• Page End: 1354
• Publication Date: 2019-06
• Subjects: Burns -- Muscle metabolism -- Amino acid kinetics -- Stable isotope -- Pediatric; AA amino acids -- B2A time from injury to admission -- B2S time from injury to metabolic study -- BF blood flow -- BIC Bayesian Information Criteria -- Ca arterial phenylalanine concentration -- CC central vein indocyanine green concentration -- CF femoral vein indocyanine green concentration -- Cv venous phenylalanine concentration -- Ea arterial enrichment -- EM free intracellular enrichment -- EP protein bound enrichment -- Ev venous enrichment -- ICG indocyanine green -- NB net balance -- Phe phenylalanine -- Ra rate of appearance -- Rd rate of disappearance -- FSR fractional synthesis rate -- SHC Shriners Hospitals for Children -- SOC standard of care -- TBSA total body surface area; Critically ill -- Nutrition -- Periodicals; Diet therapy -- Periodicals; Parenteral feeding -- Periodicals; Enteral feeding -- Periodicals; Enteral Nutrition -- Periodicals; Parenteral Nutrition -- Periodicals; Metabolism -- Periodicals; Diétothérapie -- Périodiques; Alimentation parentérale -- Périodiques; Alimentation entérale -- Périodiques; Nutrition -- Périodiques; Diet therapy; Enteral feeding; Nutrition; Parenteral feeding; Electronic journals; Periodicals; Electronic journals; 615.854
• DOI: 10.1016/j.clnu.2018.05.027
• Languages: English
• ISSNs: 0261-5614

Abstract

Summary: Background & aims: Burns remain the fifth cause of non-fatal pediatric injuries globally, with muscle cachexia being a hallmark of the stress response to burns. Burn-induced muscle wasting is associated with morbidity, yet the determinants of muscle protein catabolism in response to burn trauma remains unclear. Our objective was to determine the effect of patient and injury characteristics on muscle protein kinetics in burn patients. Methods: This retrospective, observational study was performed using protein kinetic data from pediatric patients who had severe burns (>30% of the total body surface area burned) and underwent cross-limb stable isotope infusions between 1999 and 2008 as part of prospective clinical trials. Mixed multiple regression models were used to assess associations between patient/injury characteristics and muscle protein fractional synthesis rate (FSR), net balance (NB), and rates of phenylalanine appearance (Ra; index of protein breakdown) and disappearance (Rd; index of protein synthesis) across the leg. Results: A total of 268 patients who underwent 499 studies were analyzed. Increasing time post injury was associated with greater FSR (p < 0.001) and NB (p = 0.01). Males were more catabolic than females (as indicated by lower NB, p = 0.04 and greater Ra, p = 0.008), a consequence of higher protein breakdown rather than lower synthesis. Increasing burn size was associated with higher protein synthesis rate (as indicated by higher FSR, p = 0.019) and higher protein breakdown rates (as indicated by greater Ra, p = 0.001). FSR was negatively associated with age (p < 0.001). Conclusions: Data from this large patient cohort show that injury severity, sex, and time post injury influence skeletal muscle wasting in burned children. These findings suggest that individual patient characteristics should be considered when devising therapies to improve the acute care and rehabilitation of burn survivors.