TRANSIENT ENDOTOXEMIA DURING BURN WOUND REVISION CAUSES LEUKOCYTE BETA(2) INTEGRIN UP-REGULATION AND CYTOKINE RELEASE

After severe burns, a wound revision is often done to remove devitaliz ed tissue and minimize bacterial growth. After such revision, the pati ent may show signs of sepsis. In a group of burned patients we found a transient endotoxemia, and a subsequent leukocyte activation, monitor ed as increased expression of the beta(2),-integrin CD11b, after such wound revision. In most patients we could detect elevated levels of pl asma TNF-alpha before the operation, with no increases in these levels after the operation. Plasma levels of IL-6 were elevated in all patie nts and increased after the wound revision in all patients. They also had elevated plasma levels of soluble E-selectin, indicating systemic inflammation. The close relation between endotoxin levels and CD11b ex pression, and lack of evidence for additional production of TNF-alpha, suggests that up-regulation of the beta(2) adhesion protein during wo und revision is mainly caused by endotoxin interaction with the leukoc yte.