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A Rise in Neutrophil Cell Size Precedes Organ Dysfunction After Trauma

Hesselink, Lillian*; Heeres, Marjolein*; Paraschiakos, Fotis; ten Berg, Maarten; Huisman, Albert; Hoefer, Imo E.; de Groot, Mark C.H.; van Solinge, Wouter W.; Dijkgraaf, Marcel; Hellebrekers, Pien*; Van Wessem, Karlijn J.P.*; Koenderman, Leo§; Leenen, Luke P.H.*; Hietbrink, Falco*

doi: 10.1097/SHK.0000000000001200
Clinical Science Aspects

Introduction: Organ dysfunction remains a major cause of morbidity after trauma. The development of organ dysfunction is determined by the inflammatory response, in which neutrophils are important effector cells. A femoral fracture particularly predisposes for the development of organ dysfunction. This study investigated the chronologic relation between neutrophil characteristics and organ dysfunction in trauma patients with a femoral fracture.

Methods: Patients with a femoral fracture presenting at the University Medical Center Utrecht between 2007 and 2013 were included. Data of neutrophil characteristics from standard hematological analyzers were recorded on a daily basis until the 28th day of hospital stay or until discharge. Generalized Estimating Equations were used to compare outcome groups.

Results: In total 157 patients were analyzed, of whom 81 had polytrauma and 76 monotrauma. Overall mortality within 90 days was 6.4% (n = 10). Eleven patients (7.0%) developed organ dysfunction. In patients who developed organ dysfunction a significant increase in neutrophil count (P = 0.024), a significant increase in neutrophil cell size (P = 0.026), a significant increase in neutrophil complexity (P < 0.004), and a significant decrease in neutrophil lobularity (P < 0.001) were seen after trauma. The rise in neutrophil cell size preceded the clinical manifestation of organ dysfunction in every patient.

Conclusion: Patients who develop organ dysfunction postinjury show changes in neutrophil characteristics before organ dysfunction becomes clinically evident. These findings regarding post-traumatic organ dysfunction may contribute to the development of new prognostic tools for immune-mediated complications in trauma patients.

Level of evidence: Level II, etiologic study.

*Department of Trauma Surgery, University Medical Center Utrecht, Utrecht, The Netherlands

Department of Clinical Chemistry and Hematology, University Medical Center Utrecht, Utrecht, The Netherlands

Clinical Research Unit, Academic Medical Center, Amsterdam, The Netherlands

§Laboratory for Translational Immunology and Department of Respiratory Medicine, Wilhelmina Children's Hospital, Utrecht, The Netherlands

Address reprint requests to Lillian Hesselink, MD, Department of Trauma Surgery, G04.228, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands. E-mail:

Received 23 February, 2018

Revised 2 March, 2018

Accepted 1 June, 2018

MH, KJPVW, FH, LK, and LH developed the original study design. FP, AH, MB, IEH, WWVS, MCHdG, and LH contributed to the data acquisition. FH, PH, and LH contributed to the analysis and drafted the paper. All authors approved the final manuscript.

Part of the data in this study was presented at the 46th World Congress of Surgery in Bangkok, Thailand, and at the 47th World Congress of Surgery in Basel, Switzerland.

The authors report no conflicts of interest.

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© 2019 by the Shock Society