Letter to the Editor
Sepsis biomarkers in severe burn patients: Cut-off point or time profile?
Biomarcadores de sepsis en pacientes quemados graves: ¿punto de corte o perfil temporal?
J.J. Egea-Guerrero
, A. Rodríguez-Rodríguez
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U.G.C. Cuidados Críticos y Urgencias, H.U. Virgen del Rocío, IBiS/CSIC/Universidad de Sevilla, Sevilla, Spain
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"apellidos" => "Alsina" ] 4 => array:2 [ "nombre" => "I." "apellidos" => "Jordan" ] ] ] ] ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210569116000541?idApp=WMIE" "url" => "/02105691/0000004000000009/v1_201612020641/S0210569116000541/v1_201612020641/es/main.assets" ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Sepsis biomarkers in severe burn patients: Cut-off point or time profile?" "tieneTextoCompleto" => true "saludo" => "Dear Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "595" "paginaFinal" => "596" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "J.J. Egea-Guerrero, A. Rodríguez-Rodríguez" "autores" => array:2 [ 0 => array:4 [ "nombre" => "J.J." "apellidos" => "Egea-Guerrero" "email" => array:2 [ 0 => "jjegeaguerrero@gmail.com" 1 => "juanj.egea.sspa@juntadeandalucia.es" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "A." "apellidos" => "Rodríguez-Rodríguez" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "U.G.C. Cuidados Críticos y Urgencias, H.U. Virgen del Rocío, IBiS/CSIC/Universidad de Sevilla, Sevilla, Spain" "identificador" => "aff1" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Biomarcadores de sepsis en pacientes quemados graves: ¿punto de corte o perfil temporal?" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">In regard to the review article on “Infections in critically burn patients” by Hidalgo et al., we agree on the importance of developing new strategies to improve the infection diagnosis and management of these patients.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">We concur on the lack of evidence in the use of serum biomarkers to differentiate Systemic Inflammatory Response Syndrome (SIRS) from sepsis in this population. Probably, this situation is a consequence of several factors. Firstly, sepsis diagnosis is difficult after severe thermal injury and requires the use of strict criteria described by the American Burn Association in 2007.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">2</span></a> Secondly, authors exploring the utility of specific biomarkers of infection fail to apply the same sepsis yardstick,<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">3–5</span></a> therefore published studies revealed a high level of heterogeneity. It would be due to classical sepsis definition, which includes little pathophysiological information.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">2,6</span></a> Lastly, mention that our group has explored the role of C-Reactive Protein (CRP) and Procalcitonin (PCT) for sepsis diagnosis in a small population of patients with severe burn injury.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">7</span></a> Our results show that the role of PCT in identifying infectious processes in critically burned patients is superior to CRP. Specifically, we found that increases in PCT levels showed a better discriminatory capacity for detecting sepsis, as compared to changes in CRP levels. Consequently, we consider that use of static cut-off points in this complex situation provides less information than temporal changes.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Hopefully, in the next years, through well designed multicenter studies in severe burn injury patients, we would be able to valid our hypothesis and to demonstrate that temporal profile of serum biomarkers might identify high-risk patients of sepsis after severe burn injury guiding antibiotic treatment accordingly in our intensive care units.</p><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0035" class="elsevierStylePara elsevierViewall">The authors of this paper have not received financial support or otherwise to perform this work.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflicts of interest</span><p id="par0040" class="elsevierStylePara elsevierViewall">The authors declare no conflict of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0025" "titulo" => "Funding" ] 1 => array:2 [ "identificador" => "sec0030" "titulo" => "Conflicts of interest" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:7 [ 0 => array:3 [ "identificador" => "bib0040" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Infections in critically ill burn patients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "F. 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