Early alterations of circulating immune cell counts in severe trauma patients are related to later occurrence of nosocomial infection, sepsis and mortality

Background: Severe trauma leads to extensive disturbances of the innate and adaptive arms of the immune system, which in turn may affect the prognosis. The main objective of this study was to investigate the relationship between the alterations of circulating immune cell counts in the early stage of severe trauma and the later occurrence of nosocomial infection, sepsis and mortality. Methods: This was a retrospective study of 876 patients with an Injury Severity Score (ISS) ≥ 16. Demographic data, the absolute counts of neutrophil, lymphocyte and monocyte (ANC, ALC and AMC) on days 1, 3, and 7 (D1, D3, and D7) after trauma, and whether nosocomial infection, sepsis or death occurred within 60 days were recorded. Ratios were calculated between immune cell counts of each two time points, namely day 3/day 1 (D3/D1) and day 7/day 3 (D7/D3). Patients were grouped based on ISS and the occurrence of nosocomial infection, sepsis or death. Comparative studies were conducted between each two groups. Univariate and multivariate logistic regression analysis were used to identify variables related to the risk of nosocomial infection, sepsis, and mortality. Receiver operating characteristic (ROC) curve was plotted to assess the predictive value of various risk factors. Results: More severe trauma leads to more pronounced increase in ANC and more slowly recovery of ALC. In patients with subsequent nosocomial infection and sepsis, ANC was higher and ALC recovery was slower than those without nosocomial infection and sepsis within 7 days. In non-survivors, ALC had not recovered and AMC (D3) and AMC (D7) was lower than survivors within 7 days. ALC (D3) and ALC (D3/D1) are independent risk factors for nosocomial infection and sepsis. ALC (D3), ALC (D3/D1), ALC (D7) and AMC (D7) are independent risk factors for death. The combination of ALC (D3/D1) and ALC (D3) had a good predictive value for the occurrence of nosocomial infection, sepsis, and mortality. Conclusions: More severe trauma causes more intense interference to circulating immunocyte counts. Worse alterations in circulating immunocyte counts within 7 days may increase the risk of subsequent nosocomial infection, sepsis and mortality.

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