(1614) Persistent Inflammation, Immunosuppression, and Catabolism Syndrome and Sepsis Post-Burn Injury

Introduction: Sepsis continues to be a major cause of mortality after burn injury despite advances in burn care. Burn injuries are associated with an altered immune response that can devolve into persistent inflammation, immunosuppression, and catabolism syndrome (PICS). PICS is a known cause of complications within the intensive care unit (ICU), but it remains poorly characterized among burn-injured patients. This study's objective is to determine the prevalence of PICS and associated sepsis within burn injuries at a single, large institution over the past 25 years.

Methods: We performed a detailed retrospective analysis of burn-injured adults (ages 19-65) utilizing an institutional database with de-identified patient records from 1997-2023. Data extracted included demographics, burn mechanism and size, presence of inhalational injury, as well as hospital-based metrics. Focus was placed on laboratory and clinical features consistent with PICS as well as their associations with positive culture status. Data was analyzed via Chi-Square analysis and multivariable logistic regression.

Results: A patient cohort of 960 burn-injured patients was identified who required hospitalization after a primary burn-related injury. Among them, the overall prevalence of sepsis and PICS was 38% and 25% respectively. TBSA size (p < 0.001) and the presence of inhalational injury (p < 0.001) were significant in their association with both sepsis and PICS. PICS patients had more infections per patient, with 4.3 infections per patient, compared to patients without PICS, who had 0.9 infections per patient. In addition, having PICS itself was also associated with the development of sepsis (p < 0.001). Among the criteria of PICS, lymphopenia (ALC < 1000 cells/uL) was independently associated with sepsis development (OR 3.03, 95% CI 2.14-4.29), p< 0.001).

Conclusions: Within a single burn center over the past 25 years, PICS occurred in approximately 1 in 4 burn-injured patients. Having sepsis was associated with the presence of inhalational injury and TBSA size. Additionally, sepsis was strongly associated with the PICS phenotype, of which lymphopenia was a driving feature. Future studies regarding potential interventions and therapeutics will be needed to address the PICS phenotype in this vulnerable population.