Blood lipoprotein remodelling after non-severe paediatric burns: A longitudinal analysis beyond the acute phase

Paediatric burn traumas are a global health concern shown to have long-term health consequences leading to increased morbidity and mortality. However, the underlying mechanisms contributing to these long-term health risks remain poorly understood. This study utilised 1 H Nuclear Magnetic Resonance spectroscopy to comprehensively determine the lipoproteomic changes in the acute injury phase and long-term perturbations in blood samples longitudinally collected from 142 patients. In the acute phase of burn injury 55% of the lipoprotein main fractions and subfractions were significantly altered compared to non-burn controls. The plasma profiles from the burn injury group demonstrated increased LDL (low density lipoprotein) triglyceride concentrations (adjusted p -value = 2.12x10 -9 ), an increased Apolipoprotein B100/Apolipoprotein A1 ratio (adjusted p -value = 4.29x10 -5 ) and decreased HDL (High Density Lipoprotein, adjusted p-value = 1.16x10 -11 ). At 1-year post-burn injury, it was found that 53% of the lipoprotein fraction and subfractions were altered compared to non-burn controls. The lipoproteomic profile showed a shift in LDL subfraction distribution, with a decrease in larger LDL subfractions (LDL subfraction 2 particle number, adjusted p -value = 2.52 × 10 −4 ) and an increase in smaller LDL subfractions (LDL subfraction 6 particle number, adjusted p -value = 6.47 × 10 −5 ), a pattern previously associated with cardiometabolic and cardiovascular risk. Significant lipid compositional changes of VLDL (very-low density lipoprotein), IDL (intermediate density lipoprotein), LDL and HDL were also observed at 1-year post-burn injury, notably the largest shifts were observed in IDL compared with non-burn controls. The proportion of cholesterol esters were markedly increased from 31.3% to 40.6%, free cholesterol increased from 12.8% to 15.1%, while phospholipids reduced from 29.5% to 23.3% and triglycerides reduced from 26.3% to 21.1%. Overall, this study demonstrates persistent lipoproteomic alterations following paediatric burn injury. These findings identify persistent metabolic perturbations that are not captured by conventional lipid measures, but further longitudinal studies incorporating inflammatory biomarkers and clinical cardiovascular outcomes are required to determine their clinical significance and relationship to future cardiovascular health.