30 Chapter 2 Burn-induced immune response is dominated by innate immune cells Meta-analyses were performed on outcome measures for which at least five articles were available (Supplementary Table 1). Immune cell counts in blood or wound tissue from burn-injured animals were compared with immune cell counts in blood or skin from uninjured animals (baseline or control group). Overall, there was a significant increase in leukocytes in both peripheral blood and wound tissue (Figure 3). Systemically, the numbers of neutrophils and monocytes were significantly elevated, whereas lymphocyte numbers decreased. Total leukocyte counts were higher in baseline-controlled studies than in studies with separate uninjured controls. There was no significant change in overall eosinophil or thrombocyte counts. The higher standardized mean difference of neutrophils than of total leukocytes might be caused by the decrease in lymphocyte counts. Within the lymphocyte population, only B-cell counts were significantly decreased (Figure 3B). In burn wound tissue, the numbers of neutrophils, macrophages, and mast cells were increased (Figure 3C). Cell migratory activity, mainly tested by adherence to endothelium or in vitro migration assays, was increased in total leukocytes but not in neutrophils (Figure 3D). Migratory activity of leukocytes was lower in baseline-controlled studies than in studies with separate uninjured controls. Antibacterial function of neutrophils was decreased after burn injury, whereas there was no significant effect on ROS production or inflammatory mediator secretion by neutrophils. The secretion of inflammatory mediators by macrophages was increased. There were not enough studies reporting total lymphocyte counts in wound tissue to be included in the meta-analysis.
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