Blood polymorphonuclear leukocyte migration as a predictive marker for infections in severe trauma: comparison with various inflammation parameters.
OBJECTIVE
To assess in patients with multiple trauma the relevance of the following as predictive markers for infections: the inflammation parameters white blood count, body temperature, blood polymorphonuclear leukocyte (PMN) migration; blood levels of C-reactive protein, PMN elastase, procalcitonin, neopterin, interleukin 6, interleukin 8, malondialdehyde, total antioxidative status; the stress parameters cortisol and lactate.


METHODS
Prospective observational cohort study.


METHODS
Intensive Care Unit of a university surgical department.


METHODS
Twenty-six patients with multiple trauma of differing severity.


RESULTS
Trauma severity was estimated by the ISS. PMN migration upon F-Met-Leu-Phe stimulation was determined in fresh whole blood in a ready-for-use, one-way membrane filter assay and evaluated by automated image analysis. The other parameters were measured with commercially available tests. During hospitalization, nine patients developed infections, and 17 patients were free of infection. PMN migration below a critical minimum preceded infections in eight of the infected, but occurred in only three of the non-infected patients (positive/negative predictive values 0.72/0.93; sensitivity/specificity 0.88/0.82; likelihood ratio 5.0). Fever (> or =38.0 degrees C) had predictive values of 0.83/0.80 and a high likelihood ratio of 9.4, but a low sensitivity/specificity of 0.55/0.94. The other parameters were without significance. Procalcitonin, elastase, C-reactive protein, neopterin and lactate correlated positively with the injury severity score.


CONCLUSIONS
PMN migration proved to be a highly sensitive predictive marker for infections. The whole-blood PMN migration test may facilitate early aggressive antimicrobial therapy.
Egger
Gerd
G
Institute of Pathophysiology, Karl- Franzens University, Graz, Heinrichstrasse 31, 8010, Graz, Austria. gerd.egger@eunet.at.
Aigner
Reingard
R
Department of Nuclear Medicine, University Hospital, Graz, 8036, Graz, Austria.
Glasner
Andreas
A
Department of Obstetrics and Gynecology, University Hospital, Graz , 8036, Graz, Austria.
Hofer
Herwig P
HP
Department of Traumatology, University Hospital, Graz, 8036, Graz, Austria.
Mitterhammer
Heike
H
Department of Internal Medicine, University Hospital, Graz, 8036, Graz, Austria.
Zelzer
Sieglinde
S
Institute of Clinical Chemistry and Laboratory Medicine, Karl Franzens University, Graz, 8010, Graz, Austria.
D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis; D002116:Calcitonin / Q000097:blood; D015740:Calcitonin Gene-Related Peptide; D002465:Cell Movement; D015331:Cohort Studies; D006801:Humans; D007239:Infections / Q000097:blood* / Q000209:etiology; D007375:Interleukin-1 / Q000097:blood; D016209:Interleukin-8 / Q000097:blood; D007958:Leukocyte Count; D009504:Neutrophils / Q000166:cytology*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011498:Protein Precursors / Q000097:blood; D014947:Wounds and Injuries / Q000150:complications*
D015415:Biomarkers; C000606589:CALCA protein, human; D007375:Interleukin-1; D016209:Interleukin-8; D011498:Protein Precursors; D002116:Calcitonin; D002097:C-Reactive Protein; D015740:Calcitonin Gene-Related Peptide