The extent of traumatic damage determines a graded depression of the endotoxin responsiveness of peripheral blood mononuclear cells from patients with blunt injuries
M. Majetschak et al., The extent of traumatic damage determines a graded depression of the endotoxin responsiveness of peripheral blood mononuclear cells from patients with blunt injuries, CRIT CARE M, 27(2), 1999, pp. 313-318
Objective: To study whether the endotoxin responsiveness of peripheral bloo
d mononuclear cells correlates with the severity of injury in trauma patien
ts.
Design: Prospective, observational study,
Setting: University trauma center.
Patients: Fifty-nine patients with blunt trauma (Injury Severity Score [ISS
] 4 to 57 points).
Interventions: Standard emergency department care, surgical care, and posto
perative intensive care unit treatment,
Measurements and Main Results: Whole blood and serum were obtained 94 +/- 8
9 (SD) mins post trauma (day 0) and during a 14-day period postinjury, Endo
toxin-induced tumor necrosis factor-alpha (TNF-alpha) synthesis of peripher
al blood mononuclear cells ex vivo was tested using a whole blood assay, Se
rum samples were assayed for TNF-alpha concentrations, A reduced capacity o
f whole blood to produce TNF-alpha ex vivo with endotoxin treatment was fou
nd to be closely correlated with the ISS, The capacity to produce TNF-alpha
on endotoxin stimulation of whole blood from patients with an ISS greater
than or equal to 16 points was depressed immediately after trauma and did n
ot reach normal values during the observation period, In patients with an I
SS >22 points, maximum depression of the capacity of whole blood to produce
TNF-alpha occurs within 100 mins post injury, In contrast, in patients wit
h an ISS <22 points, maximal depression of whole blood TNF-alpha production
occurs with a delay of 24 to 48 hrs after trauma, Based on pre- and postop
erative values, primary surgical intervention caused a decrease of the endo
toxin stimulated TNF-alpha production of whole blood in the latter patient
subgroup, as well as in the entire patient population (ISS 4 to 57) when se
condary surgical treatment was neccesary 5 to 13 days after trauma.
Conclusions: The extent of traumatic tissue damage leads to a graded depres
sion of immunocyte function and appears to be amplified by surgical treatme
nt. The endotoxin responsiveness of peripheral blood mononuclear cells disp
lays a functional marker of the anatomically defined severity of injury and
gives insights into the regulation of immunocyte function after severe blu
nt trauma.