Manipulation of the inflammatory response to burn injury

Background: Burn injury is characterized by hypermetabolism and protein catabolism. Endotoxin, derived from either wound or gut, may participate in this response, Methods: Eleven seriously burned patients were treated with the endotoxin-binding agent polymyxin B and underwent partitional calorimetry and nitrogen balance studies, The data from theses patients were compared with data from 28 contemporary, similarly burned patients who did not receive polymyxin B. Results: Elevated levels of circulating endotoxin were not consistently detected in either group, Interleukin-6 was elevated and correlated with rectal temperature and nitrogen excretion in both groups, Administration of polymyxin B produced no change in metabolic rate but produced a significantly more positive nitrogen balance and was associated with a prompt reduction in interleukin-6 levels, Conclusions: These data support the hypothesis that endotoxin plays a role in the postburn protein catabolism but not in the hypermetabolic response, This protein catabolic response is statistically associated with circulating interleukin-6 levels, suggesting a possible role for interleukin-6 in postinjury protein wasting.