Emma de Fraiture (Utrecht / NL), Nienke Vrisekoop (Utrecht / NL), Luke P.H. Leenen (Utrecht / NL), Karlijn van Wessem (Utrecht / NL), Leo Koenderman (Utrecht / NL), Falco Hietbrink (Utrecht / NL)
Abstract text (incl. references and figure legends)
Introduction: Infections in trauma patients are an increasing and substantial cause of morbidity, contributing to a mortality rate of 5–8% after trauma. With increased early survival rates, up to 30–50% of multitrauma patients develop an infectious complication. Trauma leads to a complex inflammatory cascade, in which neutrophils play a key role. Understanding the functions and characteristics of these cells is important for the understanding of their involvement in the development of infectious complications.
Methods: Recently, analysis of neutrophil phenotype and function as complex biomarkers, has become accessible for point-of-care decision making after trauma. The aim of this narrative review is to discuss the potential use of longitudinal assessment of the neutrophil compartment by point-of-care flow cytometry.
Results: There is an intriguing relation between the neutrophil functional phenotype on admission, and the clinical course (e.g., infectious complications) of trauma patients. Potential neutrophil based cellular diagnostics include subsets based on neutrophil receptor expression, responsiveness of neutrophils to formylpeptides and FcgRI (CD64) expression representing the infectious state of a patient.
Conclusions: It is now possible to recognize patients at risk for infectious complications when presented at the trauma bay. These patients display increased numbers of neutrophil subsets, decreased responsiveness to fMLF and/or increased CD64 expression. The next step is to measure these biomarkers over time in trauma patients at risk for infectious complications, to guide decision making regarding timing and extent of surgery and administration of (preventive) antibiotics.
Figure 1: Concept of the neutrophil subset response over time in a trauma patient at risk for infectious complications.
Figure 2: Conceptual representation of surgical strategies after trauma.
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