Splenectomy is associated with altered leukocyte kinetics after severe trauma.
Inflammation
Leukocytes
Spleen
Splenectomy
Trauma
Journal
European journal of medical research
ISSN: 2047-783X
Titre abrégé: Eur J Med Res
Pays: England
ID NLM: 9517857
Informations de publication
Date de publication:
15 Mar 2021
15 Mar 2021
Historique:
received:
19
06
2020
accepted:
04
03
2021
entrez:
16
3
2021
pubmed:
17
3
2021
medline:
20
11
2021
Statut:
epublish
Résumé
Inadequate activation of the innate immune system after trauma can lead to severe complications such as Acute Respiratory Distress Syndrome and Multiple Organ Dysfunction Syndrome. The spleen is thought to modulate the cellular immune system. Furthermore, splenectomy is associated with improved outcome in severely injured trauma patients. We hypothesized that a splenectomy alters the cellular immune response in polytrauma. All adult patients with an ISS ≥ 16 and suffering from splenic or hepatic injuries were selected from our prospective trauma database. Absolute leukocyte numbers in peripheral blood were measured. White blood cell kinetics during the first 14 days were compared between splenectomized patients, patients treated surgically for liver trauma and nonoperatively treated individuals. A total of 129 patients with a mean ISS of 29 were included. Admission characteristics and leukocyte numbers were similar in all groups, except for slightly impaired hemodynamic status in patients with operatively treated liver injuries. On admission, leukocytosis occurred in all groups. During the first 24 h, leukopenia developed gradually, although significantly faster in the operatively treated patients. Thereafter, leukocyte levels normalized in all nonoperatively treated cases whereas leukocytosis persisted in operatively treated patients. This effect was significantly more prominent in splenectomized patients than all other conditions. This study demonstrates that surgery for intra-abdominal injuries is associated with an early drop in leucocyte numbers in peripheral blood. Moreover, splenectomy in severely injured patients is associated with an altered cellular immune response reflected by a persistent state of prominent leukocytosis after trauma.
Sections du résumé
BACKGROUND
BACKGROUND
Inadequate activation of the innate immune system after trauma can lead to severe complications such as Acute Respiratory Distress Syndrome and Multiple Organ Dysfunction Syndrome. The spleen is thought to modulate the cellular immune system. Furthermore, splenectomy is associated with improved outcome in severely injured trauma patients. We hypothesized that a splenectomy alters the cellular immune response in polytrauma.
METHODS
METHODS
All adult patients with an ISS ≥ 16 and suffering from splenic or hepatic injuries were selected from our prospective trauma database. Absolute leukocyte numbers in peripheral blood were measured. White blood cell kinetics during the first 14 days were compared between splenectomized patients, patients treated surgically for liver trauma and nonoperatively treated individuals.
RESULTS
RESULTS
A total of 129 patients with a mean ISS of 29 were included. Admission characteristics and leukocyte numbers were similar in all groups, except for slightly impaired hemodynamic status in patients with operatively treated liver injuries. On admission, leukocytosis occurred in all groups. During the first 24 h, leukopenia developed gradually, although significantly faster in the operatively treated patients. Thereafter, leukocyte levels normalized in all nonoperatively treated cases whereas leukocytosis persisted in operatively treated patients. This effect was significantly more prominent in splenectomized patients than all other conditions.
CONCLUSIONS
CONCLUSIONS
This study demonstrates that surgery for intra-abdominal injuries is associated with an early drop in leucocyte numbers in peripheral blood. Moreover, splenectomy in severely injured patients is associated with an altered cellular immune response reflected by a persistent state of prominent leukocytosis after trauma.
Identifiants
pubmed: 33722293
doi: 10.1186/s40001-021-00497-8
pii: 10.1186/s40001-021-00497-8
pmc: PMC7958390
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
26Références
Crit Care Med. 2002 Aug;30(8):1717-21
pubmed: 12163782
J Exp Med. 2006 Jul 10;203(7):1623-8
pubmed: 16785311
Immunol Invest. 2012;41(1):61-74
pubmed: 21877936
Arch Surg. 1988 Dec;123(12):1519-24
pubmed: 3056336
Surg Infect (Larchmt). 2001 Winter;2(4):289-93; discussion 294-5
pubmed: 12593704
J Trauma. 2000 Apr;48(4):599-604; discussion 604-5
pubmed: 10780590
Am J Physiol. 1987 Sep;253(3 Pt 2):H699-703
pubmed: 3631303
World J Emerg Surg. 2017 Aug 18;12:40
pubmed: 28828034
J Immunol. 1979 Aug;123(2):616-21
pubmed: 110877
World J Emerg Surg. 2006 May 20;1:15
pubmed: 16759367
Crit Care. 2004 Dec;8(6):453-61
pubmed: 15566616
Eur J Med Res. 2010 Jun 28;15(6):258-65
pubmed: 20696635
J Immunol. 2006 Feb 15;176(4):2085-94
pubmed: 16455964
J Trauma. 2003 May;54(5 Suppl):S203-6
pubmed: 12768126
J Trauma. 1995 Sep;39(3):411-7
pubmed: 7473901
Am J Blood Res. 2013 Aug 19;3(3):239-45
pubmed: 23997986
Surgery. 2007 Jan;141(1):32-40
pubmed: 17188165
Intensive Care Med. 1995 Apr;21(4):302-9
pubmed: 7650252
Mol Med. 2009 Jul-Aug;15(7-8):263-7
pubmed: 19593410
J Trauma. 1974 Mar;14(3):187-96
pubmed: 4814394
Am J Clin Pathol. 1973 Sep;60(3):337-42
pubmed: 4728140
Transpl Immunol. 2012 Aug;27(1):8-11
pubmed: 22484617
Am J Physiol Lung Cell Mol Physiol. 2000 Dec;279(6):L1137-45
pubmed: 11076804
Injury. 2012 Feb;43(2):180-3
pubmed: 21696725
J Trauma. 2011 Jul;71(1):141-7
pubmed: 21248654
Curr Opin Crit Care. 2008 Dec;14(6):666-72
pubmed: 19005307
Blood. 2004 Jul 15;104(2):565-71
pubmed: 15054039
Injury. 1999 Apr;30(3):179-85
pubmed: 10476263
Crit Care Med. 1996 Jul;24(7):1125-8
pubmed: 8674323
J Trauma. 2007 Jun;62(6):1396-403; discussion 1403-4
pubmed: 17563655
Injury. 2005 Jun;36(6):691-709
pubmed: 15910820
J Leukoc Biol. 2008 Mar;83(3):640-7
pubmed: 18156186
Nat Rev Immunol. 2005 Aug;5(8):606-16
pubmed: 16056254
J Immunol. 2008 Sep 1;181(5):3535-9
pubmed: 18714026
J Trauma. 2009 Aug;67(2):289-95
pubmed: 19667881
Lancet. 2014 Oct 18;384(9952):1455-65
pubmed: 25390327
Ann Surg. 1993 Dec;218(6):769-76
pubmed: 8257227
J Trauma Acute Care Surg. 2013 Jun;74(6):1446-53
pubmed: 23694871
J Trauma. 2001 Sep;51(3):452-6; discussion 456-7
pubmed: 11535890
Eur J Med Res. 2009 Jul 22;14(7):284-91
pubmed: 19661010
J Trauma. 1996 Apr;40(4):501-10; discussion 510-2
pubmed: 8614027
J Exp Med. 2011 Dec 19;208(13):2581-90
pubmed: 22110166
Crit Care Med. 1992 Jun;20(6):864-74
pubmed: 1597042
Liver. 1996 Jun;16(3):188-94
pubmed: 8873006
J Trauma. 1999 May;46(5):774-81; discussion 781-3
pubmed: 10338393
J Clin Invest. 2012 Jan;122(1):327-36
pubmed: 22156198
Eur J Trauma Emerg Surg. 2018 Apr;44(Suppl 1):1
pubmed: 29623341
Immunology. 2008 Nov;125(3):281-8
pubmed: 19128361
Ann Surg. 1992 Aug;216(2):117-34
pubmed: 1503516
Crit Care Med. 2004 Feb;32(2):439-42
pubmed: 14758161
Liver. 2002 Dec;22(6):467-73
pubmed: 12445171
Thromb Haemost. 2009 Jan;101(1):36-47
pubmed: 19132187