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


CONCLUSIONS
Peripheral blood PMN apoptosis in the early resuscitative period is associated with decreased incidence of subsequent infection in T/HS patients.
Michael E. DeBakey Department of Surgery, Section of Infectious Disease, Baylor College of Medicine, Houston, TX 77007, USA. camorris@bcm.edu
C
C
Anne Morrison
Ana
A
Moran
Shruti
S
Patel
Maria del Pilar Huby
Mdel P
Vidaurre
Matthew M
MM
Carrick
David J
DJ
Tweardy
D018784:Abdominal Abscess / Q000097:blood* / Q000382:microbiology; D000328:Adult; D017209:Apoptosis / Q000502:physiology*; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D015994:Incidence; D016014:Linear Models; D008297:Male; D009504:Neutrophils / Q000276:immunology / Q000473:pathology*; D009707:Nucleosomes / Q000378:metabolism; D059035:Perioperative Period; D011014:Pneumonia / Q000097:blood* / Q000382:microbiology; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D018805:Sepsis / Q000097:blood / Q000382:microbiology; D012771:Shock, Hemorrhagic / Q000097:blood* / Q000382:microbiology; D018709:Statistics, Nonparametric; D014949:Wounds, Nonpenetrating / Q000097:blood / Q000382:microbiology / Q000601:surgery; D014950:Wounds, Penetrating / Q000097:blood* / Q000601:surgery
D009707:Nucleosomes