Immunological factors of pain and infection in patients with burns

Control of pain and infection constitute continuing challenges in patients with
burns. Although behavioural studies describe many influencing factors,
biological mechanisms of pain are still unsufficiently understood. A recent
study in rats, showed an interesting connection between pro-inflammatory
cytokines and pain. The current study will investigate this correlation in
patients with burns. In addition, we will explore a possible connection between
psychological distress, pro-inflammatory cytokines, and pain. We hypothesize
that a higher level of pro-inflammatory cytokines is associated with higher
psychological stress, and higher self-reported pain. An important confounder of
immunological factors in the pain study, is infection; infected wounds are more
painful and influence the immunological factors. For that reason,
microbiological and/or infection status will be documented in detail and will
be controlled for in the analysis.
The second part of this study focusses on infection. Prevention of microbial
contamination and infection is vital for burn wound care. In burn wounds,
Staphylococcus aureus and Pseudomonas aeruginosa are the most frequently
isolated microbial species. Bacterial presence can result in wound healing
problems but not in all patients. One factor that may predispose patients to P.
aeruginosa is part of the inflammatory response after skin injury: the
mannose-binding lectin (MBL). MBL is a broad-spectrum pattern recognition
molecule that plays a key role in innate immunity. A growing consensus from
studies in humans and mice suggests that a low serum level of MBL together with
other comorbid factors predisposes the host to increased susceptibility to
infection. We hypothesize that low levels of MBL increases the risk of
bacterial colonisation.

First, to explore relationships between immunological factors (cytokines and
chemokines), psychological stress, and pain, controlled for infection.
Second, to explore relationships between immunological factors (MBL), bacterial
colonisation and wound healing.

Prospective observational cohort study with a duration of 1.5 year.

The burden of the study is limited to the completion of questionnaires during
the study period. To our knowledge, the completion of questionnaires is not
associated with any risk for the subjects.

The blood punction procedures are embedded in the clinical routine. On one
occasion - after having given informed consent - an extra blood tube will be
taken during a clinical routine vena punction. Importantly, there is no
punction for research purposes only.