Variation of Pro- and Anti-Inflammatory Factors in Severe Burns: A Systematic Review

TL;DR

This systematic review explores how pro- and anti-inflammatory factors change after severe burns, affecting recovery or complications like sepsis.

Contribution

The study provides a comprehensive synthesis of inflammatory dynamics in severe burns, emphasizing non-linear immune responses.

Findings

The inflammatory response to burns is dynamic, not linear.

Outcomes depend more on persistent dysregulated inflammation than initial cytokine levels.

Compensatory mechanisms failure worsens outcomes.

Abstract

Burn injury triggers a complex inflammatory cascade in which the interplay between pro- and anti-inflammatory mediators determines recovery or progression to sepsis, ventilator-associated pneumonia (VAP) or multi-organ dysfunction, and mortality. We systematically searched PubMed, Embase, Cochrane Library, Web of Science, and Scopus for studies published between 2006 and 2024, identifying 1883 records. We conducted a comprehensive systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. After screening and eligibility assessment, 24 studies covering both pediatric and adult populations met the inclusion criteria. Data on cytokines, acute-phase proteins, complement fragments, and systemic inflammatory indices were synthesized narratively. The evidence indicates that the inflammatory response to burn injury is not a linear sequence of events but a dynamic and unstable equilibrium, where outcomes are determined less by the initial magnitude of cytokine release and more by the persistence of dysregulated inflammation or failure of compensatory mechanisms.

Figures