Impact of proper nutritional support on IL-10 level in Burned Patients
Background: Patients suffering from severe burns develop metabolic imbalances and systemic inflammatory response syndrome (SIRS) which can lead to malnutrition,impaired immunologic response,multiple organ failure and death. Prolonged and persistent hyper catabolism is characterized by the loss of lean body mass,as well as progressive decrease of host defenses that impairs the immunological response and lead to sepsis. Studies have shown that providing an early and adequate nutrition support can lower the adverse effects of exaggerated hyper metabolic response,reducing morbidity,and improves outcome. This study was designed to assess the effectiveness of adequate nutritional support on IL-10 levels in thermally burn patients. Methods: Thirty Patients with severe thermal burn (>20% of Total Body Surface Area [TBSA] burned) on the first day in the ICU,joined this single-blinded randomized controlled clinical trial. Patients were randomly divided into two groups: control group (group C,15 patient),received hospital routine diet (liquid and chow diet ad libitum) while Intervention group (group I,15 patients) received commercially prepared solution with oral or tube feeding. The caloric requirement for Intervention group was calculated according to the Harris- Benedict formula. IL-10 level was measured at day 1 and 9 of admission,The Sequential Organ Failure Assessment (SOFA) score was measured on admission (SOFA0),day 2 (SOFA1),day5 (SOFA2),and day 9(SOFA3) consequently. The difference between last measurement (SOFA3) and day 2 (SOFA1) was calculated. Results: The results showed that IL-10 level at day 9 were significantly decreased in intervention group [-4.00(-20.00,- 1) vs. -1.90(-39.00,12.15) p=0.002]. There was also a significant change between SOFA3,[1.0(0.0,2.0) vs. 2.0(1.0,3.0),p = 0.039]. As a consequence,we suggest the use of SOFA measurement as a reliable predictor of IL-10. Conclusion: This study shows that an adequate nutritional support is a fundamental part of clinical treatment in thermally burned patients. A proper enteral nutritional support in patients with severe burn injury can improve SOFA Score which correlates with a lower IL-10 level,because of decrease in negative nitrogen balance and improved immunity leading to decrease in the incidence of infection. In summary,we believe that health care providers and policy makers should pay closer attention to nutrition factor as it plays a key role in improving clinical outcome.