Background
Methods
Research setting and study participants
Data collection
Outcome measurements
Experiment methodology
Lymphocyte count
Flow cytometry
ELISA
Patient selection
Data analysis and statistics
Results
Early changes in lymphocyte subpopulations are associated with the development of MODS
Demographics | Controls | No MODS | MODS |
p value |
---|---|---|---|---|
n | 8 | 19 | 11 | - |
% male | 100 | 83 | 77 | 0.38 |
Age‡
| 32 (26–35) | 35 (27–44) | 34 (27–52) | 0.71 |
ISS‡
| 1 (1–2) | 10 (9–18) | 33 (25–50) | <0.01 |
Base deficit (mmol/L)‡
| −1.9 (−2.3 to −1.0) | −0.5 (−1.4 to −1.6) | 3.8 (2.4–7.9) | <0.01 |
Time of sample from injury (mins)‡
| 66 (60–78) | 67 (54–75) | 85 (70–95) | 0.09 |
CSL pre-draw (ml)‡
| 0 (0) | 0 (0) | 500 (0–500) | <0.01 |
SBP on arrival (mmHg)‡
| 140 (135–149) | 139 (131–145) | 109 (96–125) | <0.01 |
Hospital length of stay (days)‡
| 2 (1–3) | 7 (3–14) | 20 (8–39) | 0.07 |
ICU length of stay (days)‡
| 0 (0) | 0 (0) | 8 (2–13) | <0.01 |
28-day mortality % (n) | 0 (0) | 0 (0) | 31 | <0.01 |
Percentage†
| ||||
Lymphocytes | 18 (12–24) | 18 (12–23) | 17 (8–27) | 0.95 |
Total NK cells | 16 (7–24) | 14 (11–17) | 23 (16–29) | 0.02 |
NK bright | 0.6 (0.2–1.0) | 1.3 (0.4–2.2) | 0.8 (0.4–1.1) | 0.12 |
NK dim | 15 (7–23) | 13 (10–16) | 22 (16–28) | <0.01 |
Gamma delta high | 0.7 (0.4–1.0) | 1.4 (0.2–2.5) | 1.8 (0.0–3.9) | 0.86 |
Gamma delta low | 2.1 (1.2–2.9) | 4.0 (2.5–5.5) | 0.9 (0.5–1.4) | <0.01 |
T helpers | 32 (26–38) | 32 (28–36) | 35 (29–41) | 0.28 |
Cytotoxic T cells | 23 (18–27) | 28 (23–33) | 21 (17–25) | 0.16 |
Cell count × 109/L†
| ||||
Lymphocytes | 2.0 (1.3–3.2) | 1.4 (0.4–5.1) | 2.5 (1.7–3.6) | 0.80 |
Total NK cells | 0.2 (0.1–0.6) | 0.5 (0.2–0.7) | 0.6 (0.2–0.9) | 0.14 |
NK bright | 0.01 (0.01–0.02) | 0.03 (0.01–0.05) | 0.02 (0.01–0.03) | 0.20 |
NK dim | 0.2 (0.1–0.5) | 0.4 (0.2–0.6) | 0.5 (0.2–0.8) | 0.12 |
Gamma delta high | 0.01 (0.01–0.03) | 0.04 (0.00–0.09) | 0.06 (0.00–0.16) | 0.73 |
Gamma delta low | 0.03 (0.01–0.08) | 0.09 (0.06–0.12) | 0.02 (0.01–0.03) | <0.01 |
T helpers | 0.6 (0.4–0.8) | 0.9 (0.7–1.1) | 0.7 (0.5–0.9) | 0.08 |
Cytotoxic T cells | 0.4 (0.3–0.7) | 0.8 (0.6–1.0) | 0.5 (0.3–0.7) | 0.46 |
Cytokine levels indicate early innate lymphocyte activation
Lymphopenia is associated with early innate lymphocyte aberrations, MODS and mortality
Demographics | No MODS | MODS |
p value |
---|---|---|---|
n | 187 (67) | 93 (33) | - |
% male | 147 (79) | 76 (83) | 0.63 |
Age‡
| 39 (25–57) | 39 (26–51) | 0.36 |
ISS‡
| 26 (22–34) | 34 (26–41) | <0.01 |
Base deficit (mmol/L)‡
| 3.7 (1.3–7.3) | 4.7 (2.4–8.4) | 0.02 |
SBP on arrival (mmHg)‡ | 126 (98–144) | 122 (86–147) | 0.16 |
PRBC (units)‡
| 2 (0–6) | 3 (0–8) | 0.42 |
SOFA on admission‡
| 9 (8–10) | 10 (8–11) | 0.03 |
Hospital length of stay (days)‡
| 25 (14–38) | 33 (24–50) | <0.01 |
ICU length of stay (days)‡
| 8 (5–12) | 16 (10–23) | <0.01 |
Infection % | 76 (41) | 61 (66) | <0.01 |
28-day mortality % | 15 (8) | 9 (10) | 0.65 |
Variable | Univariate | B (SE) | Odds ratio (95 % CI) |
p value |
---|---|---|---|---|
Included | ||||
LC 48 h | <0.01 | −2.05 (0.47) | 0.13 (0.05–0.32) | <0.01 |
BD | <0.01 | 0.07 (0.03) | 1.07 (1.01–1.13) | 0.01 |
ISS | <0.01 | 0.02 (0.01) | 1.02 (1.00–1.05) | 0.05 |
Constant | - | −0.00 (0.56) | - | - |
Excluded | ||||
24 h PRBC | 0.07 | |||
Age | 0.34 | |||
Gender | 0.39 | |||
SBP | 0.82 |
Discussion
Conclusions
Key messages
-
Lymphocyte activity within 2 h of injury is associated with the development of MODS and lymphopenia after trauma.
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Development of MODS is associated with high NK dim cells and low γδ-low T lymphocyte populations at admission.
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Lymphopenia occurs within 24 h after severe injury and persists in patients with MODS
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Patients with a lymphocyte count ≤ 0.5 × 109/L at 48 h had a 45 % mortality rate