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- Open Access
T-helper cell polarisation following severe polytrauma
© Torrance et al.; 2015
- Published: 1 October 2015
- Intensive Care Unit
- Nosocomial Infection
- Intensive Care Unit Stay
- Royal College
- White Cell Count
Severe polytrauma induces an immunosuppressive response and is associated with a very high incidence of nosocomial infections. Previous studies have inferred that this detrimental immune response results from polarisation of the T helper (Th) response towards an anti-inflammatory, TH2 dominated, response at the expense of a bactericidal, Th1 response .
1) To define alterations in TH cell subsets following severe blunt polytrauma.
Patients presenting to the emergency department within 2 hours of severe polytrauma were eligible if intubated either at the scene or in ED. Isolated head injuries and those not expected to survive 24 hours were excluded. EDTA anti-coagulated blood was drawn at 0hr (within 2 hours of injury), at 24 and 72hrs. Samples were immediately lysed, washed, stained and analysed using a standardised human 8-colour TH 1, 2 & 17 panel  on an LSR II flow cytometer. A paired white cell count differential was obtained at each sampling point. Patients were followed until discharge or death. Data were analysed using non-parametric statistics, with results presented as median and IQR.
Severe polytrauma patients swiftly become lymphopenic. Although a failure to normalise this during the ICU stay correlates with higher mortality  our study of TH cell subtypes demonstrates no evidence of a switch to a detrimental anti-inflammatory TH2 subtype at the expense of the potentially protective bactericidal TH1 subtype.
Royal College of Surgeons of England, Barts & the London Charity.
- Marik PE, Flemmer M: The immune response to surgery and trauma: Implications for treatment. J Trauma Acute Care Surg. 2012, 73: 801-8. 10.1097/TA.0b013e318265cf87.PubMedView ArticleGoogle Scholar
- Maecker HT, et al: Standardizing immunophenotyping for the Human Immunology Project. Nat Rev Immunol. 2012, 12: 191-200.PubMedPubMed CentralGoogle Scholar
- Heffernan DS, et al: Failure to normalize lymphopenia following trauma is associated with increased mortality, independent of the leukocytosis pattern. Crit Care. 2012, 16: R12-10.1186/cc11157.PubMedPubMed CentralView ArticleGoogle Scholar
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