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

  • Anne Morrison C
  • Moran A
  • Patel S
 et al. 
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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.

Author-supplied keywords

  • Abdominal Abscess
  • Abdominal Abscess: blood
  • Abdominal Abscess: microbiology
  • Adult
  • Apoptosis
  • Apoptosis: physiology
  • Female
  • Heart Rate
  • Heart Rate: physiology
  • Humans
  • Incidence
  • Linear Models
  • Male
  • Neutrophils
  • Neutrophils: immunology
  • Neutrophils: pathology
  • Nucleosomes
  • Nucleosomes: metabolism
  • Perioperative Period
  • Pneumonia
  • Pneumonia: blood
  • Pneumonia: microbiology
  • Prospective Studies
  • Randomized Controlled Trials as Topic
  • Sepsis
  • Sepsis: blood
  • Sepsis: microbiology
  • Shock, Hemorrhagic
  • Shock, Hemorrhagic: blood
  • Shock, Hemorrhagic: microbiology
  • Statistics, Nonparametric
  • Wounds, Nonpenetrating
  • Wounds, Nonpenetrating: blood
  • Wounds, Nonpenetrating: microbiology
  • Wounds, Nonpenetrating: surgery
  • Wounds, Penetrating
  • Wounds, Penetrating: blood
  • Wounds, Penetrating: surgery

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  • C Anne Morrison

  • Ana Moran

  • Shruti Patel

  • Maria Del Pilar Huby Vidaurre

  • Matthew M Carrick

  • David J Tweardy

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