Recent studies have identified protein C (PC) as a viable early biomarker in burns to assist traditional evaluation methods for diagnostic and prognostic purposes. Previous findings from a single institution link early depletion of the PC system to greater burn severity and worse outcomes. We present here for the first time a NSW statewide study to validate and extend our earlier reports, and to compare PC to other well-known burns markers.
This was a prospective cohort study conducted at Concord Repatriation General Hospital and Royal North Shore Hospital in Sydney, two adult burns referral centres capturing a statewide population of 8 million. Blood samples were collected within 24 hours of admission for PC, C-reactive protein, procalcitonin, prealbumin, and neutrophils. Comprehensive injury severity, treatment, and outcome data were also prospectively collected.
Eighty-six patients were recruited (64 from RNSH and 22 from CRGH). Admission PC was the only marker strongly correlated with all burn severity measures – size (p<0.001), predominant depth (p<0.001), and presence of inhalational injury (p=0.040). Admission PC levels alone were further consistently associated with all outcome metrics measured – total (p<0.001) and ICU (p<0.001) length of stays, mean daily IV fluids over the first three days (p<0.001), number of surgeries (p<0.001), number of ventilated (p<0.001) and dialysed (p=0.013) days, sepsis (p<0.001), HAP/VAP (p=0.016), and mortality (p=0.027).
An early reduction in circulating PC compromises one of the body’s most important cytoprotective reserves, ensuring poorer global outcomes, and highlights PC’s versatility as a prognostic marker of outcomes in severe burn injuries.