Visualization of the inflammatory response to injury by neutrophil phenotype categories: Neutrophil phenotypes after trauma

Emma J de Fraiture, Suus H Bongers, Bernard N Jukema, Leo Koenderman, Nienke Vrisekoop, Karlijn J P van Wessem, Luke P H Leenen, Falco Hietbrink

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Abstract

PURPOSE: The risk of infectious complications after trauma is determined by the amount of injury-related tissue damage and the resulting inflammatory response. Recently, it became possible to measure the neutrophil phenotype in a point-of-care setting. The primary goal of this study was to investigate if immunophenotype categories based on visual recognition of neutrophil subsets are applicable to interpret the inflammatory response to trauma. The secondary goal was to correlate these immunophenotype categories with patient characteristics, injury severity and risk of complications.

METHODS: A cohort study was conducted with patients presented at a level 1 trauma center with injuries of any severity, who routinely underwent neutrophil phenotyping. Data generated by automated point-of-care flow cytometry were prospectively gathered. Neutrophil phenotypes categories were defined by visual assessment of two-dimensional CD16/CD62L dot plots. All patients were categorized in one of the immunophenotype categories. Thereafter, the categories were validated by multidimensional analysis of neutrophil populations, using FlowSOM. All clinical parameters and endpoints were extracted from the trauma registry.

RESULTS: The study population consisted of 380 patients. Seven distinct immunophenotype Categories (0-6) were defined, that consisted of different neutrophil populations as validated by FlowSOM. Injury severity scores and risk of infectious complications increased with ascending immunophenotype Categories 3-6. Injury severity was similarly low in Categories 0-2.

CONCLUSION: The distribution of neutrophil subsets that were described in phenotype categories is easily recognizable for clinicians at the bedside. Even more, multidimensional analysis demonstrated these categories to be distinct subsets of neutrophils. Identification of trauma patients at risk for infectious complications by monitoring the immunophenotype category is a further improvement of personalized and point-of-care decision-making in trauma care.

Original languageEnglish
Pages (from-to)1023-1034
Number of pages12
JournalEuropean Journal of Trauma and Emergency Surgery
Volume49
Issue number2
Early online date8 Nov 2022
DOIs
Publication statusPublished - Apr 2023

Keywords

  • Infection
  • Inflammation
  • Injury
  • Neutrophil
  • Trauma

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