严重创伤患者免疫细胞计数变化轨迹与脓毒症的后期发生及死亡率相关：917例病例的回顾性研究
The Trajectory of Alterations in Immune-Cell Counts in Severe-Trauma Patients Is Related to the Later Occurrence of Sepsis and Mortality: Retrospective Study of 917 Cases.
作者信息
Dong Xijie, Wang Chuntao, Liu Xinghua, Bai Xiangjun, Li Zhanfei
机构信息
Trauma Center, Department of Emergency and Traumatic Surgery, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
出版信息
Front Immunol. 2021 Jan 8;11:603353. doi: 10.3389/fimmu.2020.603353. eCollection 2020.
BACKGROUND
Severe trauma is believed to disrupt the homeostasis of the immune system, and lead to dramatic changes in the circulating immune-cell count (ICC). The latter fluctuates widely over time. Knowledge about the relationship between these dramatic changes and dynamic fluctuations and the late prognosis of trauma patients is sparse. We investigated the relationship between the trajectory of alterations in the circulating ICC within 7 days in severe-trauma patients and subsequent sepsis and mortality.
METHODS
A retrospective analysis of 917 patients with an Injury Severity Score ≥16 was undertaken. The absolute neutrophil, lymphocyte, and monocyte counts (ANC, ALC, and AMC, respectively) on days 1, 3, and 7 (D1, D3, and D7, respectively) after trauma, and whether sepsis or death occurred within 60 days, were recorded. As the disordered circulating ICCs fluctuated widely, their time-varying slopes (D3/D1 and D7/D3) were calculated. Patients were divided into "sepsis" and "non-sepsis" groups, as well as "alive" and "death" groups. Comparative studies were conducted between every two groups. Univariate and multivariate logistic regression analyses were used to identify variables related to the risk of sepsis and mortality. Receiver operating characteristic curves were plotted to assess the predictive value of various risk factors.
RESULTS
More severe trauma caused more pronounced increases in the ANC and slower recovery of the ALC within 7 days. The ALC (D3), ANC (D7), ALC (D3/D1), and ANC (D7/D3) were independent risk factors for sepsis. The ALC (D3), ALC (D7), AMC (D7), and ALC (D3/D1) were independent risk factors for mortality. A combination of the ALC (D3) and ALC (D3/D1) exerted a good predictive value for sepsis and death.
CONCLUSIONS
The trajectory of alterations in the circulating ICC in the early stage after trauma is related to subsequent sepsis and mortality.
背景
严重创伤被认为会破坏免疫系统的稳态，并导致循环免疫细胞计数（ICC）发生显著变化。后者会随时间大幅波动。关于这些显著变化与动态波动之间的关系以及创伤患者的远期预后的知识较为匮乏。我们研究了严重创伤患者7天内循环ICC变化轨迹与随后发生的脓毒症及死亡率之间的关系。
方法
对917例损伤严重度评分≥16的患者进行回顾性分析。记录创伤后第1天、第3天和第7天（分别为D1、D3和D7）的绝对中性粒细胞、淋巴细胞和单核细胞计数（分别为ANC、ALC和AMC），以及60天内是否发生脓毒症或死亡。由于紊乱的循环ICC波动很大，计算了它们的时变斜率（D3/D1和D7/D3）。患者被分为“脓毒症”组和“非脓毒症”组，以及“存活”组和“死亡”组。对每两组进行比较研究。采用单因素和多因素逻辑回归分析来确定与脓毒症和死亡风险相关的变量。绘制受试者工作特征曲线以评估各种危险因素的预测价值。
结果
更严重的创伤导致7天内ANC升高更明显，ALC恢复更慢。ALC（D3）、ANC（D7）、ALC（D3/D1）和ANC（D7/D3）是脓毒症的独立危险因素。ALC（D3）、ALC（D7）、AMC（D7）和ALC（D3/D1）是死亡的独立危险因素。ALC（D3）和ALC（D3/D1）的组合对脓毒症和死亡具有良好的预测价值。
结论
创伤后早期循环ICC的变化轨迹与随后的脓毒症和死亡率相关。
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