Department of Trauma Surgery, University Medical Center Utrecht, P.O. Box 85500, 3508 GA, Utrecht, Netherlands.
Department of Trauma Surgery, Sint Antonius Hospital, Utrecht, The Netherlands.
Eur J Trauma Emerg Surg. 2023 Apr;49(2):1023-1034. doi: 10.1007/s00068-022-02134-3. Epub 2022 Nov 8.
The risk of infectious complications after trauma is determined by the amount of injury-related tissue damage and the resulting inflammatory response. Recently, it became possible to measure the neutrophil phenotype in a point-of-care setting. The primary goal of this study was to investigate if immunophenotype categories based on visual recognition of neutrophil subsets are applicable to interpret the inflammatory response to trauma. The secondary goal was to correlate these immunophenotype categories with patient characteristics, injury severity and risk of complications.
A cohort study was conducted with patients presented at a level 1 trauma center with injuries of any severity, who routinely underwent neutrophil phenotyping. Data generated by automated point-of-care flow cytometry were prospectively gathered. Neutrophil phenotypes categories were defined by visual assessment of two-dimensional CD16/CD62L dot plots. All patients were categorized in one of the immunophenotype categories. Thereafter, the categories were validated by multidimensional analysis of neutrophil populations, using FlowSOM. All clinical parameters and endpoints were extracted from the trauma registry.
The study population consisted of 380 patients. Seven distinct immunophenotype Categories (0-6) were defined, that consisted of different neutrophil populations as validated by FlowSOM. Injury severity scores and risk of infectious complications increased with ascending immunophenotype Categories 3-6. Injury severity was similarly low in Categories 0-2.
The distribution of neutrophil subsets that were described in phenotype categories is easily recognizable for clinicians at the bedside. Even more, multidimensional analysis demonstrated these categories to be distinct subsets of neutrophils. Identification of trauma patients at risk for infectious complications by monitoring the immunophenotype category is a further improvement of personalized and point-of-care decision-making in trauma care.
创伤后感染并发症的风险取决于与损伤相关的组织损伤程度和由此产生的炎症反应。最近，人们有可能在即时检测环境中测量中性粒细胞表型。本研究的主要目的是研究基于视觉识别中性粒细胞亚群的免疫表型类别是否适用于解释创伤后的炎症反应。次要目标是将这些免疫表型类别与患者特征、损伤严重程度和并发症风险相关联。
对在 1 级创伤中心就诊的各种严重程度损伤的患者进行了队列研究，这些患者常规进行中性粒细胞表型分析。通过自动化即时检测流式细胞术前瞻性地收集数据。中性粒细胞表型类别的定义是通过二维 CD16/CD62L 点图的视觉评估来确定的。所有患者都被归入一个免疫表型类别。然后，使用 FlowSOM 对中性粒细胞群体进行多维分析，对这些类别进行验证。所有临床参数和终点均从创伤登记处提取。
研究人群包括 380 例患者。定义了七个不同的免疫表型类别（0-6），这些类别通过 FlowSOM 验证了不同的中性粒细胞群体。随着免疫表型类别 3-6 的升高，损伤严重程度评分和感染性并发症风险增加。0-2 类的损伤严重程度也相似。
在表型类别中描述的中性粒细胞亚群的分布易于临床医生在床边识别。更重要的是，多维分析表明这些类别是中性粒细胞的不同亚群。通过监测免疫表型类别来识别感染性并发症风险的创伤患者，是创伤护理中个性化和即时检测决策的进一步改进。
