ENDOTHELIN-1 AND PROSTAGLANDIN E(2) LEVELS INCREASE IN PATIENTS WITH BURNS

BACKGROUND: Endothelin-1 (ET-1), a powerful vasoconstrictor, is a 21 a mino acid peptide produced by endothelium. It negatively affects pulmo nary, cardiac, hepatic, and renal function. It also constricts bronchi al and gut smooth muscle. This peptide also stimulates monocytes to pr oduce prostaglandin E(2) (PGE(2)), tumor necrosis factor, interleukin- 6 and 8, and substances that stimulate neutrophil superoxide productio n. Plasma levels of ET-1 also increase in shock, low flow states, isch emia, and sepsis. STUDY DESIGN: Fourteen patients between the ages of seven and 72 years were admitted to the Bridgeport Hospital Burn Unit and resuscitated with a modified Parkland formula. Plasma was drawn on admission, at 12, 24, and 48 hours. Endothelin-1 and PGE(2) were meas ured by radioimmunoassay. RESULTS: Endothelin-1 levels increased ten- to 20-fold in all patients. Prostaglandin E(2) levels increased five-t o 40-fold in all patients. There was no correlation between plasma ET- 1 or PGE(2) levels with either size of burn, inhalation injury, patien t age, organ dysfunction, or survival in this small study of early bur n injury. CONCLUSIONS: The increased plasma ET-1 response in patients with burns may have a role in the genesis of the systemic response to burns. This peptide may also activate monocyte production of PGE(2) an d other mediators of the systemic inflammatory response syndrome. This study was done to measure ET-1 and PGE(2) levels in patients with bur ns greater than 20 percent of the body surface area on admission, at 1 2, 24, and 48 hours. The correlations between severity of burn, ET-1 l evels, and PGE(2) production were also assessed.