CORRELATION OF THE LOCAL AND SYSTEMIC CYTOKINE RESPONSE WITH CLINICALOUTCOME FOLLOWING THERMAL-INJURY

Eighty-eight patients with acute thermal injury were evaluated. Forty- eight hours after injury, TNF, IL-6, and IL-8 were significantly prese nt in the systemic circulation, lung, normal skin, and thermally injur ed skin. The presence of TNF, IL-6, and IL-8 proteins in the lung, nor mal skin, and thermally injured skin were associated with TNF, IL-6, a nd IL-8 mRNA upregulation. Logistic regression analysis controlling fo r the Abbreviated Burn Severity Index demonstrated that the presence o f IL-8 in the lung was associated with early pulmonary physiologic dys function (p = 0.006) and nosocomial pulmonary infection (p = 0.040). W e conclude that acute thermal injury initiates an early systemic, lung , and skin response involving TNF, IL-6, and IL-8. The TNF, IL-6, and IL-8 protein present in the lung and skin in response to acute thermal injury are generated locally and do not originate from the systemic c ytokine pool. The lung cytokine response to acute thermal injury may i nitiate local organ failure.