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Abstract
Introduction
Major trauma is accompanied by a marked inflammatory reaction that involves infiltration
of blood polymorphonuclear leucocytes (PMNs) into the injured area. This process is
dynamic and evolves rapidly over the first 24–72 hours after injury. Activated PMNs
can contribute to tissue damage by release of oxygen radicals, proteolytic enzymes
and proinflammatory cytokines. The acute respiratory distress syndrome (ARDS) that
occurs early after major trauma is characterized by a neutrophil infiltrate within
the lungs. Also the inflammation, in response to brain injury, involves infiltration
of neutrophils into the injured brain parenchyma.
Purpose
The aim of the study was to test the hypothesis that the outcome of severe traumatized
patients would be influenced by the PMN count.
Methods
From December 2004 to November 2005, 40 multiple injured patients (28 male, 12 female,
mean age 39 ± 18 years old) admitted to our ICU were retrospectively studied. The
study protocol was approved by the local ethics committee. Ten of them had severe
brain injury (GCS < 8) and 30 were admitted after major multiple trauma (ISS > 20).
From the hematologic tests of the first 2 days post injury drawn from their records,
the total peripheral leukocyte count, absolute neutrophil count and absolute lymphocyte
count were recorded. The average values of the first 2 days for total leucocytes,
absolute neutrophils and absolute lymphocytes were calculated for each patient. The
overall outcome of the patients in the hospital was also recorded. The Student t test
and the chi-square test were used for statistical analysis.
Results
Patients were divided into two groups according to their outcome. The absolute neutrophil
count in survivors was significantly lower than those in nonsurvivors (P = 0.01).
No significant difference was found in total leukocyte count and absolute lymphocyte
count between the groups. The mortality rate was significantly higher in patients
with absolute neutrophils >8000 than in those with absolute neutrophils <8000 (P =
0.03). See Table 1.
Table 1
Outcome
Total leukocyte
Absolute neutrophils
Absolute lymphocytes
Survivors
14,429 ± 5438
10,318 ± 4018
2163 ± 1860
Nonsurvivors
16,362 ± 5176
13,283 ± 4725*
1948 ± 1161
P value
NS
P = 0.01
NS
*Statistically significant.
Conclusion
A high absolute neutrophil count detected at the first and second day after severe
injury is associated with an increased mortality. This finding must be verified in
a prospective study with a large number of traumatized patients.