Persistent inflammation, immunosuppression, and catabolism syndrome and sepsis in pediatric burns.

OBJECTIVE

To determine the prevalence of persistent inflammation, immunosuppression, and catabolism syndrome (PIICS) and associated sepsis in children with burn injuries at a single, large institution over the past 25 years.

BACKGROUND

Despite advances in care, sepsis after burn injury continues to have a significant contribution to morbidity and mortality. This risk is compounded by an altered immune state after burn injury that can induce PIICS. While the presence of this dysregulated immunophenotype in pediatric burns is widely accepted, it remains poorly characterized.

METHODS

We performed a retrospective analysis of pediatric burn injuries utilizing an institutional database with de-identified patient records (1997-2023).

RESULTS

In the cohort of 287 patients, the overall prevalence of sepsis and PIICS among burn-injured children was 30 % and 15 %, respectively. The presence of inhalation injury and the total body surface area (TBSA) burned were both strongly associated with the development of sepsis and PIICS. While those with PIICS had more infections per patient compared to patients without PIICS, there was no difference in the pathogen profile between the two groups. Having PIICS itself was independently associated with the development of sepsis, and among the laboratory and clinical criteria, we found that lymphopenia had the strongest association.

CONCLUSION

PIICS occurred in approximately 1 in 6 pediatric patients with burn injury. The development of PIICS is closely associated with the development of sepsis during hospitalization. Among the laboratory and clinical criteria, lymphopenia was most strongly associated with a septic event, suggesting that its presence should heighten concern about the development of serious infections in this vulnerable population.