Extravascular lung water index as a sign of developing sepsis in burns Z. Bognar *, V. Foldi, B. Rezman, L. Bogar, C. Csontos Department of Anaesthesia and Intensive Care, Faculty of Medicine, University of Pecs, Aka ´c u. 1, Pe ´cs 7632, Hungary 1. Introduction Burned patients are susceptible to infections because of the anti-inflammatory processes caused by trauma [1–4]. Despite improvements in burn wound care and intensive therapy, sepsis and consequent multiple organ failure (MOF) remain the major causes of death in patients suffering from severe thermal injury [5,6]. Burned patients show signs of systemic inflammatory response syndrome (SIRS) without bacterial infection making early detection of sepsis difficult. Sepsis is usually diagnosed from clinical signs [7]. Early and adequate administration of antibiotics may improve patients’ survival [8–10]. Based on the Surviving Sepsis Campaign, administra- tion of the first dose of antibiotics is necessary within 1 h following diagnosis. Due to existing SIRS the haemodynamic profile of burn injury in septic patients is very similar to the non-septic profile, characterized by high cardiac index (CI) and low systemic vascular resistance index (SVRI). By using transpul- monary thermodilution extravascular lung water index (EVLWI) can be calculated and monitored. It has been shown that inhalation injury and fluid resuscitation per se rarely influence EVLWI alone [11–13], although an elevated EVLWI can often be detected during the treatment of burned patients in the intensive care unit (ICU). According to Tranbaugh et al. elevated EVLWI may be a sign of developing bacterial sepsis in burned patients [11]. Yang et al. showed that EVLWI has a prognostic value in critically ill patient suffering from septic shock. EVLWI >14 ml kg À1 has been associated with a significantly higher in-hospital mortality [14]. burns 36 (2010) 1263–1270 article info Article history: Accepted 5 April 2010 Keywords: Extravascular lung water index Procalcitonin Sepsis Burn Scoring systems abstract Sepsis and multiple organ failure remain the leading cause of mortality and morbidity in burns. The aim of our study was to analyse the predictive value of extravascular lung water index (EVLWI) in the development of severe septic complications and mortality. The records of 28 patients with total burned surface area >20% were analysed (EVLWI, procalcitonin (PCT), intrathoracic blood volume index (ITBVI), positive end-expiratory pressure (PEEP), Baltimore Sepsis Scale (BaSS)). Diagnosis of infection (day 0) was based on consensus conference of the American Burn Association. EVLWI correlated with PCT (r = 0.597), and PEEP (r = 0.501) on day 0 and with BaSS (r = 0.524) and MODS (r = 0.513) from day 1. EVLWI was elevated ( p < 0.05) from one day before diagnosis of infection, PCT was higher ( p < 0.05) from day 0 only. ROC analysis for EVLWI on day À1 and for PCT on day 0 showed similar areas under curve (0.760; 0.766). EVLWI >9 ml kg À1 on day À1 predicted sepsis (89% sensitivity, 72% specificity). After antibiotic treatment EVLWI remained high in non-survivors, decreased in survivors, where- as PCT decreased in both groups. Our data suggest that EVLWI is an early warning sign of developing infection and its continuous elevation can predict poor prognosis in burns. # 2010 Elsevier Ltd and ISBI. All rights reserved. * Corresponding author. Tel.: +36 309375104; fax: +36 72536800/6960. E-mail addresses: bognarzsu@gmail.com (Z. Bognar), csaba.csontos@gmail.com (C. Csontos). available at www.sciencedirect.com journal homepage: www.elsevier.com/locate/burns 0305-4179/$36.00 # 2010 Elsevier Ltd and ISBI. All rights reserved. doi:10.1016/j.burns.2010.04.006