van Eerten F J C, de Fraiture E J, Duebel L V, Vrisekoop N, van Wessem K J P, Koenderman L, Hietbrink F
Department of Trauma Surgery, University Medical Center Utrecht, Utrecht, Netherlands.
CTI Center Translational Immunology, University Medical Center Utrecht, Utrecht, Netherlands.
Eur J Trauma Emerg Surg. 2024 Dec;50(6):3049-3058. doi: 10.1007/s00068-024-02574-z. Epub 2024 Jul 9.
Trauma triggers a systemic inflammatory cellular response due to tissue damage, potentially leading to a secondary immune deficiency. Trauma severity is quantified by the Injury Severity Score (ISS). Severe Traumatic Brain Injury (TBI) is associated with high ISSs due to high lethality, despite limited tissue damage. Therefore, ISS might overestimate the post-traumatic inflammatory cellular response. This study investigated the effect of TBI on the occurrence of different systemic neutrophil phenotypes as alternative read-out for systemic inflammation.
A single-center retrospective cohort study was conducted at a level-1 trauma center. Patients aged ≥ 18 years, admitted between 01-03-2021-01-11-2022 and providing a diagnostic blood sample were included. Four groups were created: isolated TBI, isolated non-TBI, multitrauma TBI and multitrauma non-TBI. Primary outcome was occurrence of different neutrophil phenotypes determined by automated flow cytometry. Secondary outcome was infectious complications.
In total, 404 patients were included. TBI and non-TBI patients demonstrated similar occurrences of different neutrophil phenotypes. However, isolated TBI patients had higher ISSs than their isolated non-TBI controls who suffered similar post-traumatic inflammatory cellular responses. Regardless of the type of injury, patients exhibiting higher systemic inflammation had a high infection risk.
When TBI is involved, ISS tends to be higher compared to similar patients in the absence of TBI. However, TBI patients did not demonstrate an increased inflammatory cellular response compared to non-TBI patients. Therefore, TBI does not add much to the inflammatory cellular response in trauma patients. The degree of the inflammatory response was related to the incidence of infectious complications.
创伤会因组织损伤引发全身性炎症细胞反应，有可能导致继发性免疫缺陷。创伤严重程度通过损伤严重度评分（ISS）来量化。严重创伤性脑损伤（TBI）尽管组织损伤有限，但由于致死率高，ISS评分也高。因此，ISS可能高估了创伤后的炎症细胞反应。本研究调查了TBI对不同全身中性粒细胞表型发生情况的影响，以此作为全身炎症的替代指标。
在一家一级创伤中心进行了一项单中心回顾性队列研究。纳入年龄≥18岁、在2021年3月1日至2022年11月1日期间入院并提供诊断性血样的患者。分为四组：单纯TBI组、单纯非TBI组、多发伤合并TBI组和多发伤合并非TBI组。主要结局是通过自动流式细胞术测定的不同中性粒细胞表型的发生情况。次要结局是感染性并发症。
共纳入404例患者。TBI患者和非TBI患者不同中性粒细胞表型的发生情况相似。然而，单纯TBI患者的ISS评分高于遭受类似创伤后炎症细胞反应的单纯非TBI对照组。无论损伤类型如何，全身炎症较高的患者感染风险也较高。
当涉及TBI时，与无TBI的类似患者相比，ISS往往更高。然而，与非TBI患者相比，TBI患者并未表现出炎症细胞反应增加。因此，TBI对创伤患者的炎症细胞反应影响不大。炎症反应程度与感染性并发症的发生率相关。
