TY - JOUR
T1 - A Rise in Neutrophil Cell Size Precedes Organ Dysfunction After Trauma
AU - Hesselink, Lillian
AU - Heeres, Marjolein
AU - Paraschiakos, Fotis
AU - ten Berg, Maarten
AU - Huisman, Albert
AU - Hoefer, Imo E.
AU - de Groot, Mark C. H.
AU - van Solinge, Wouter W.
AU - Dijkgraaf, Marcel
AU - Hellebrekers, Pien
AU - van Wessem, Karlijn J. P.
AU - Koenderman, Leo
AU - Leenen, Luke P. H.
AU - Hietbrink, Falco
PY - 2019
Y1 - 2019
N2 - INTRODUCTION: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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 OF EVIDENCE: Level II, etiologic study.
AB - INTRODUCTION: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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 OF EVIDENCE: Level II, etiologic study.
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85062939046&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/29889813
U2 - https://doi.org/10.1097/SHK.0000000000001200
DO - https://doi.org/10.1097/SHK.0000000000001200
M3 - Article
C2 - 29889813
SN - 1073-2322
VL - 51
SP - 439
EP - 446
JO - Shock (Augusta, Ga.)
JF - Shock (Augusta, Ga.)
IS - 4
ER -