de Fraiture E J, Vrisekoop N, Leenen L P H, van Wessem K J P, Koenderman L, Hietbrink F
Department of Trauma Surgery, University Medical Center Utrecht, Utrecht, Netherlands.
Department of Surgery, Sint Antonius Hospital, Nieuwegein, Netherlands.
Front Med (Lausanne). 2022 Sep 20;9:983259. doi: 10.3389/fmed.2022.983259. eCollection 2022.
Infections in trauma patients are an increasing and substantial cause of morbidity, contributing to a mortality rate of 5-8% after trauma. With increased early survival rates, up to 30-50% of multitrauma patients develop an infectious complication. Trauma leads to a complex inflammatory cascade, in which neutrophils play a key role. Understanding the functions and characteristics of these cells is important for the understanding of their involvement in the development of infectious complications. Recently, analysis of neutrophil phenotype and function as complex biomarkers, has become accessible for point-of-care decision making after trauma. There is an intriguing relation between the neutrophil functional phenotype on admission, and the clinical course (e.g., infectious complications) of trauma patients. Potential neutrophil based cellular diagnostics include subsets based on neutrophil receptor expression, responsiveness of neutrophils to formyl-peptides and FcγRI (CD64) expression representing the infectious state of a patient. It is now possible to recognize patients at risk for infectious complications when presented at the trauma bay. These patients display increased numbers of neutrophil subsets, decreased responsiveness to fMLF and/or increased CD64 expression. The next step is to measure these biomarkers over time in trauma patients at risk for infectious complications, to guide decision making regarding timing and extent of surgery and administration of (preventive) antibiotics.
创伤患者的感染是发病率不断上升的一个重要原因，导致创伤后死亡率达到5%-8%。随着早期生存率的提高，多达30%-50%的多发伤患者会发生感染性并发症。创伤会引发复杂的炎症级联反应，其中中性粒细胞起关键作用。了解这些细胞的功能和特性对于理解它们在感染性并发症发生过程中的作用很重要。最近，对中性粒细胞表型和功能作为复杂生物标志物的分析，已可用于创伤后床边决策。入院时中性粒细胞功能表型与创伤患者的临床病程（如感染性并发症）之间存在着有趣的关系。基于中性粒细胞的潜在细胞诊断方法包括基于中性粒细胞受体表达的亚群、中性粒细胞对甲酰肽的反应性以及代表患者感染状态的FcγRI（CD64）表达。现在，在创伤急诊室就能识别出有感染性并发症风险的患者。这些患者表现出中性粒细胞亚群数量增加、对fMLF的反应性降低和/或CD64表达增加。下一步是对有感染性并发症风险的创伤患者随时间测量这些生物标志物，以指导关于手术时机和范围以及（预防性）抗生素使用的决策。
