Persistence of muscle catabolism after severe burn

D. W. Hart, S. E. Wolf, R. Mlcak, D. L. Chinkes, P. I. Ramzy, M. K. Obeng, A. A. Ferrando, R. R. Wolfe, D. N. Herndon

Research output: Contribution to journalArticle

350 Citations (Scopus)

Abstract

Background. The hypermetabolic response to severe burn is characterized by muscle protein catabolism. Current opinion states that the hypermetabolic state resolves soon after complete wound closure. Clinically, we have witnessed that burned children appear to be hypermetabolic and catabolic long after full healing of their wounds. Our goal in this study was to determine scientifically if burn-associated hypermetabolism persists after full wound healing. Methods. To determine the duration of muscle catabolism and systemic hypermetabolism after severe burn in children, patients with > 40 % total body surface area bums were enrolled in a prospective, longitudinal study; resting energy expenditure was measured by indirect calorimetry, muscle protein kinetics were determined by using stable isotopic methodology, and body composition was measured by dual-energy x-ray absorptiometry imaging. Data were collected at 6, 9, and 12 months after injury. Results. The mean total body surface area burned was 65% ± 13%, and the mean age was 7.6 ± 1.5 years. Resting energy expenditure was elevated above the predicted age-matched levels from the Harris-Benedict equation and incrementally declined throughout the 12-month study. The net protein balance and lean mass reflected catabolic persistence at 6 and 9 months after severe burn. Between 9 and 12 months, protein breakdown decreased, net protein balance improved, and lean body mass increased. Conclusions. In severely burned children, hypermetabolism and catabolism remain exaggerated for at least 9 months after injury. This suggests that therapeutic attempts to manipulate the catabolic and hypermetabolic response to severe injury should be continued long after injury.

Original languageEnglish (US)
Pages (from-to)312-319
Number of pages8
JournalSurgery
Volume128
Issue number2
DOIs
StatePublished - 2000

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Muscles
Wounds and Injuries
Muscle Proteins
Body Surface Area
Wound Healing
Energy Metabolism
Indirect Calorimetry
Proteins
Body Composition
Burns
Longitudinal Studies
X-Rays
Prospective Studies
Therapeutics

ASJC Scopus subject areas

  • Surgery

Cite this

Hart, D. W., Wolf, S. E., Mlcak, R., Chinkes, D. L., Ramzy, P. I., Obeng, M. K., ... Herndon, D. N. (2000). Persistence of muscle catabolism after severe burn. Surgery, 128(2), 312-319. https://doi.org/10.1067/msy.2000.108059

Persistence of muscle catabolism after severe burn. / Hart, D. W.; Wolf, S. E.; Mlcak, R.; Chinkes, D. L.; Ramzy, P. I.; Obeng, M. K.; Ferrando, A. A.; Wolfe, R. R.; Herndon, D. N.

In: Surgery, Vol. 128, No. 2, 2000, p. 312-319.

Research output: Contribution to journalArticle

Hart, DW, Wolf, SE, Mlcak, R, Chinkes, DL, Ramzy, PI, Obeng, MK, Ferrando, AA, Wolfe, RR & Herndon, DN 2000, 'Persistence of muscle catabolism after severe burn', Surgery, vol. 128, no. 2, pp. 312-319. https://doi.org/10.1067/msy.2000.108059
Hart DW, Wolf SE, Mlcak R, Chinkes DL, Ramzy PI, Obeng MK et al. Persistence of muscle catabolism after severe burn. Surgery. 2000;128(2):312-319. https://doi.org/10.1067/msy.2000.108059
Hart, D. W. ; Wolf, S. E. ; Mlcak, R. ; Chinkes, D. L. ; Ramzy, P. I. ; Obeng, M. K. ; Ferrando, A. A. ; Wolfe, R. R. ; Herndon, D. N. / Persistence of muscle catabolism after severe burn. In: Surgery. 2000 ; Vol. 128, No. 2. pp. 312-319.
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N2 - Background. The hypermetabolic response to severe burn is characterized by muscle protein catabolism. Current opinion states that the hypermetabolic state resolves soon after complete wound closure. Clinically, we have witnessed that burned children appear to be hypermetabolic and catabolic long after full healing of their wounds. Our goal in this study was to determine scientifically if burn-associated hypermetabolism persists after full wound healing. Methods. To determine the duration of muscle catabolism and systemic hypermetabolism after severe burn in children, patients with > 40 % total body surface area bums were enrolled in a prospective, longitudinal study; resting energy expenditure was measured by indirect calorimetry, muscle protein kinetics were determined by using stable isotopic methodology, and body composition was measured by dual-energy x-ray absorptiometry imaging. Data were collected at 6, 9, and 12 months after injury. Results. The mean total body surface area burned was 65% ± 13%, and the mean age was 7.6 ± 1.5 years. Resting energy expenditure was elevated above the predicted age-matched levels from the Harris-Benedict equation and incrementally declined throughout the 12-month study. The net protein balance and lean mass reflected catabolic persistence at 6 and 9 months after severe burn. Between 9 and 12 months, protein breakdown decreased, net protein balance improved, and lean body mass increased. Conclusions. In severely burned children, hypermetabolism and catabolism remain exaggerated for at least 9 months after injury. This suggests that therapeutic attempts to manipulate the catabolic and hypermetabolic response to severe injury should be continued long after injury.

AB - Background. The hypermetabolic response to severe burn is characterized by muscle protein catabolism. Current opinion states that the hypermetabolic state resolves soon after complete wound closure. Clinically, we have witnessed that burned children appear to be hypermetabolic and catabolic long after full healing of their wounds. Our goal in this study was to determine scientifically if burn-associated hypermetabolism persists after full wound healing. Methods. To determine the duration of muscle catabolism and systemic hypermetabolism after severe burn in children, patients with > 40 % total body surface area bums were enrolled in a prospective, longitudinal study; resting energy expenditure was measured by indirect calorimetry, muscle protein kinetics were determined by using stable isotopic methodology, and body composition was measured by dual-energy x-ray absorptiometry imaging. Data were collected at 6, 9, and 12 months after injury. Results. The mean total body surface area burned was 65% ± 13%, and the mean age was 7.6 ± 1.5 years. Resting energy expenditure was elevated above the predicted age-matched levels from the Harris-Benedict equation and incrementally declined throughout the 12-month study. The net protein balance and lean mass reflected catabolic persistence at 6 and 9 months after severe burn. Between 9 and 12 months, protein breakdown decreased, net protein balance improved, and lean body mass increased. Conclusions. In severely burned children, hypermetabolism and catabolism remain exaggerated for at least 9 months after injury. This suggests that therapeutic attempts to manipulate the catabolic and hypermetabolic response to severe injury should be continued long after injury.

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