Increased apoptosis of peripheral blood neutrophils is associated with reduced incidence of infection in trauma patients with hemorrhagic shock

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  • A. M
  • S. P
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Abstract

Objective: We aimed to describe the relationship between early peripheral leukocyte apoptosis and incidence of subsequent infection in trauma patients with hemorrhagic shock (T/HS). Methods: T/HS patients requiring emergency surgery were prospectively enrolled. Nucleosome ELISA and TUNEL staining were performed on peripheral blood drawn pre-operatively, post-operatively and at 24 h. Subjects were followed for 30 days or until death or hospital discharge to record all episodes of infection. Results: Forty-one subjects were enrolled. Six died within 24 h of surgery and were not included in the analysis. Nucleosome levels peaked post-operatively and dropped to baseline levels at 24 h (p = 0.03). TUNEL analysis revealed that polymorphonuclear neutrophils (PMNs) accounted for 72% of apoptotic leukocytes; the remaining apoptotic cells were mainly lymphocytes. Increased post-operative leukocyte apoptosis was associated with decreased systemic inflammatory response syndrome (SIRS) severity. Seventeen of the 35 survivors (48.6%) developed infections, while 18 (51.4%) did not. Pre-operative and post-operative nucleosome levels were 2.5 and 3 times higher, respectively, in T/HS patients who did not develop infection compared to those who did. Increased nucleosome levels were associated in particular with protection against sepsis (p=0.03) and multiple infections (p = 0.01). Conclusion: Peripheral blood PMN apoptosis in the early resuscitative period is associated with decreased incidence of subsequent infection in T/HS patients. © 2012 The British Infection Association.

Author-supplied keywords

  • *apoptosis
  • *hemorrhagic shock
  • *infection
  • *neutrophil
  • abdominal abscess
  • adult
  • article
  • bacteremia
  • clinical article
  • controlled study
  • disease severity
  • empyema
  • enzyme linked immunosorbent assay
  • female
  • follow up
  • human
  • human cell
  • lymphocyte
  • male
  • mixed infection
  • nick end labeling
  • nucleosome
  • pneumonia
  • prospective study
  • resuscitation
  • sepsis
  • systemic inflammatory response syndrome
  • urinary tract infection
  • wound infection

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Authors

  • Anne Morrison C.

  • Moran A.

  • Patel S.

  • Vidaurre M.P.H.

  • Carrick M.M.

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