Serum concentration of amino-terminal propeptide of type III procollagen (PIIINP) as a prognostic marker for skin fibrosis after scar correction in burned patients

The amino-terminal propeptide of procollagen type III (PIIINP) has been proposed as a marker for fibrogenesis in patients with different fibroproliferative disorders, e.g. liver and lung fibrosis. In this study, serum concentrations of PIIINP were measured by ELISA as a marker for excessive cicatrization in burned patients before and after scar correction. All patients were followed 6 months to determine a new fibrotic reaction during the wound healing process using the Burn Scar Index and to correlate pre- and post-operative concentrations of PIIINP in their sera with the risk to develop a new severe tissue fibrosis leading to pathological scar formation. Furthermore, PIIINP was determined in the excised scar tissue by immunohistochemistry. The study included 38 patients. Nineteen patients (8 female, 1 I male, average age 48.3 +/- 18.9 years) had hypertrophic scars after major burn injury (TBSA, 21 +/- 12%; Burn Scar Index, 10.4 +/- 3.7 points) and underwent scar correction. Nineteen patients (12 female, 7 male, average age 42.3 +/- 25.5 years) who underwent elective plastic-surgical operations served as the control group. Blood samples were drawn immediately before operation, at the 1st, 3rd, 7th, and 14th post-operative days, as well as 1 st, 3rd, and 6th months after operation. Pre-operatively, PIIINP was significantly elevated (P < 0.05) in burned patients who underwent scar correction. There was a significant increase (P < 0.05) of PIIINP in burned patients from 9.8 +/- 3.7 ng/ml pre-operatively to 13.9 +/- 4.2 ng/ml at the 7th post-operation day. Up to 3 months after operation, the 6 months after scar correction concentration remained at a significantly elevated level compared to pre-operative values. The burned patients had a Burn Scar Index of 7.8 +/- 3.6 points. Pre-operative PIIINP serum concentrations correlated with the Burn Scar Index (r(2) = 0.7 and 0.68; P < 0.05). Scar tissue stained intensively positive for PIIINP There was a significant correlation between pre-operative serum values and degree of immunostaining (r(2) = 0.45; P < 0.05). The increased concentration of PIIINP seen in our burned patients' sera might serve as a marker for the extent of skin fibrosis and for the risk of developing new severe fibrotic reactions after scar correction. (C) 2002 Elsevier Science Ltd and ISBI. All rights reserved.