A Rise in Neutrophil Cell Size Precedes Organ Dysfunction After Trauma

器官功能障碍 多发伤 医学 免疫功能障碍 多器官功能障碍综合征 内科学 勃起功能障碍 中性粒细胞绝对计数 免疫系统 免疫学 外科 败血症 毒性 中性粒细胞减少症
作者
Lillian Hesselink,Marjolein Heeres,Fotis Paraschiakos,Maarten ten Berg,Albert Huisman,Imo E. Hoefer,Mark de Groot,Wouter W. van Solinge,Marcel G. W. Dijkgraaf,Pien Hellebrekers,Karlijn J. P. van Wessem,Leo Koenderman,Luke P.H. Leenen,Falco Hietbrink
出处
期刊:Shock [Ovid Technologies (Wolters Kluwer)]
卷期号:51 (4): 439-446 被引量:18
标识
DOI:10.1097/shk.0000000000001200
摘要

Organ dysfunction remains a major cause of morbidity after trauma. The development of organ dysfunction is determined by the inflammatory response, in which neutrophils are important effector cells. A femoral fracture particularly predisposes for the development of organ dysfunction. This study investigated the chronologic relation between neutrophil characteristics and organ dysfunction in trauma patients with a femoral fracture.Patients with a femoral fracture presenting at the University Medical Center Utrecht between 2007 and 2013 were included. Data of neutrophil characteristics from standard hematological analyzers were recorded on a daily basis until the 28th day of hospital stay or until discharge. Generalized Estimating Equations were used to compare outcome groups.In total 157 patients were analyzed, of whom 81 had polytrauma and 76 monotrauma. Overall mortality within 90 days was 6.4% (n = 10). Eleven patients (7.0%) developed organ dysfunction. In patients who developed organ dysfunction a significant increase in neutrophil count (P = 0.024), a significant increase in neutrophil cell size (P = 0.026), a significant increase in neutrophil complexity (P < 0.004), and a significant decrease in neutrophil lobularity (P < 0.001) were seen after trauma. The rise in neutrophil cell size preceded the clinical manifestation of organ dysfunction in every patient.Patients who develop organ dysfunction postinjury show changes in neutrophil characteristics before organ dysfunction becomes clinically evident. These findings regarding post-traumatic organ dysfunction may contribute to the development of new prognostic tools for immune-mediated complications in trauma patients.Level II, etiologic study.
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