title: Neutrophil oxidative burst capacity for peri-operative immune monitoring in trauma patients.
abstract: BACKGROUND
  Post injury immune dysfunction can result in serious complications. Measurement of biomarkers may guide the optimal timing of surgery in clinically borderline patients and therefore prevent complications.
  
  
  OBJECTIVE
  peri-operative measurement of neutrophil oxidative burst capacity as an indicator of the immune response to major orthopaedic surgical procedures.
  
  
  METHODS
  Prospective cohort study of trauma patients aged ≥16 yrs with pelvic, acetabular, femoral shaft or tibial shaft fractures requiring surgical intervention. Blood samples were taken immediately pre-op and at 30 min, 7, 24 and 72-9 6 h post-operatively. Neutrophil oxidative burst capacity was measured both with and without stimulation by formyl-methionyl-leucyl-phenylalanine (fMLP, a chemotactic factor). Clinical outcomes measured were mortality, length of stay, MOF, pneumonia, acute respiratory distress syndrome (ARDS) and sepsis.
  
  
  RESULTS
  100 consecutive orthopaedic trauma patients were enrolled over a 16 month period. 78% were male, with a mean age of 42 ± 18 years and an average ISS of 19 ± 13. Neutrophil oxidative burst capacity was significantly elevated at 7 h (p = 0.006) and 24 h (p = 0.022) post operatively. Patients who developed infective complications (pneumonia and sepsis) had higher levels of oxidative burst capacity pre-operatively (pneumonia: 1.52 ± 0.93 v 0.99 ± 0.66 p = 0.032, sepsis: 1.39 ± 0.86 v 0.97 ± 0.56 p = 0.024) and at 24 h post op (pneumonia: 2.72 ± 2.38 v 1.12 ± 0.63 p = < 0.001, sepsis: 2.16 ± 2.09 v 1.10 ± 0.54 p = < 0.001). When analysed by operation type, no statistical difference was seen between major and minor operations. No correlation was found between length of stay, length of ICU stay, ISS or age and neutrophil oxidative burst capacity at any time point.
  
  
  CONCLUSIONS
  Neutrophil oxidative burst capacity response to orthopaedic trauma surgery is associated with the infective post injury complications. There was no correlation between magnitude of injury or operation and oxidative burst capacity. These results are promising for the development of tools for prediction of post-operative complications and guidance for optimal timing for surgical intervention.
authors.affiliation: Department of Traumatology, Division of Surgery, John Hunter Hospital and University of Newcastle, Locked Bag 1, Newcastle 2310, NSW, Australia.
authors.forename: William
authors.initials: W
authors.lastname: Lumsdaine
authors.affiliation: Department of Traumatology, Division of Surgery, John Hunter Hospital and University of Newcastle, Locked Bag 1, Newcastle 2310, NSW, Australia.
authors.forename: Ruth Miriam
authors.initials: RM
authors.lastname: Easton
authors.affiliation: Department of Traumatology, Division of Surgery, John Hunter Hospital and University of Newcastle, Locked Bag 1, Newcastle 2310, NSW, Australia.
authors.forename: Natalie Jane
authors.initials: NJ
authors.lastname: Lott
authors.affiliation: Department of Traumatology, Division of Surgery, John Hunter Hospital and University of Newcastle, Locked Bag 1, Newcastle 2310, NSW, Australia.
authors.forename: Amanda
authors.initials: A
authors.lastname: White
authors.affiliation: Department of Traumatology, Division of Surgery, John Hunter Hospital and University of Newcastle, Locked Bag 1, Newcastle 2310, NSW, Australia.
authors.forename: Theo L de
authors.initials: TL
authors.lastname: Malmanche
authors.affiliation: Department of Traumatology, Division of Surgery, John Hunter Hospital and University of Newcastle, Locked Bag 1, Newcastle 2310, NSW, Australia.
authors.forename: Karla
authors.initials: K
authors.lastname: Lemmert
authors.affiliation: Department of Traumatology, Division of Surgery, John Hunter Hospital and University of Newcastle, Locked Bag 1, Newcastle 2310, NSW, Australia.
authors.forename: Dieter Georg
authors.initials: DG
authors.lastname: Weber
authors.affiliation: Department of Traumatology, Division of Surgery, John Hunter Hospital and University of Newcastle, Locked Bag 1, Newcastle 2310, NSW, Australia. Electronic address: Zsolt.Balogh@hnehealth.nsw.gov.au.
authors.forename: Zsolt J
authors.initials: ZJ
authors.lastname: Balogh
mesh_terms: D000077:Acetabulum / Q000293:injuries; D000328:Adult; D015331:Cohort Studies; D005260:Female; D005269:Femur / Q000293:injuries; D005593:Fracture Fixation, Internal / Q000009:adverse effects; D050723:Fractures, Bone / Q000150:complications / Q000276:immunology* / Q000401:mortality; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D015166:Monitoring, Immunologic / Q000379:methods; D009102:Multiple Organ Failure / Q000276:immunology* / Q000401:mortality; D009240:N-Formylmethionine Leucyl-Phenylalanine / Q000276:immunology*; D009504:Neutrophils / Q000276:immunology* / Q000378:metabolism; D010388:Pelvis / Q000293:injuries; D011014:Pneumonia / Q000276:immunology* / Q000401:mortality; D011446:Prospective Studies; D016897:Respiratory Burst / Q000276:immunology*; D012128:Respiratory Distress Syndrome / Q000276:immunology*; D013977:Tibia / Q000293:injuries; D013997:Time Factors
chemical_list: D009240:N-Formylmethionine Leucyl-Phenylalanine
keywords: Biological markers; Immune monitoring; Multiple organ failure; Second hit; Surgery; Trauma