Neutrophil heterogeneity and its role in infectious complications after severe trauma
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(2019) 14:24
REVIEW
Open Access
Neutrophil heterogeneity and its role in infectious complications after severe trauma Lillian Hesselink1,2*† , Roy Spijkerman1,2†, Karlijn J. P. van Wessem1, Leo Koenderman2, Luke P. H. Leenen1, Markus Huber-Lang3 and Falco Hietbrink1
Abstract Background: Trauma leads to a complex inflammatory cascade that induces both immune activation and a refractory immune state in parallel. Although both components are deemed necessary for recovery, the balance is tight and easily lost. Losing the balance can lead to life-threatening infectious complications as well as long-term immunosuppression with recurrent infections. Neutrophils are known to play a key role in these processes. Therefore, this review focuses on neutrophil characteristics and function after trauma and how these features can be used to identify trauma patients at risk for infectious complications. Results: Distinct neutrophil subtypes exist that play their own role in the recovery and/or development of infectious complications after trauma. Furthermore, the refractory immune state is related to the risk of infectious complications. These findings change the initial concepts of the immune response after trauma and give rise to new biomarkers for monitoring and predicting inflammatory complications in severely injured patients. Conclusion: For early recognition of patients at risk, the immune system should be monitored. Several neutrophil biomarkers show promising results and analysis of these markers has become accessible to such extent that they can be used for point-of-care decision making after trauma. Keywords: Neutrophil, Trauma, Infection, Immune response
Background Both mortality and morbidity after trauma have globally decreased in the past decades [1]. However, trauma remains the leading cause of death in people under the age of 40 worldwide [2, 3]. The reason that more patients survive the initial trauma nowadays is mainly due to advances in (surgical) hemorrhage control and resuscitation [4]. However, after this first critical phase, patients can deteriorate again due to immune-related complications, such as an overwhelming immune response, severe infections, or recurrent infections later on [5, 6].
* Correspondence: [email protected] † Lillian Hesselink and Roy Spijkerman contributed equally to this work. 1 Department of Trauma Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands 2 Laboratory of Translational Immunology and Department of Respiratory Medicine, University Medical Centre Utrecht, Utrecht, The Netherlands Full list of author information is available at the end of the article
After trauma, the injury induces an immediate innate immune response to protect disrupted barriers from pathogens, to clear tissue damage, and to induce healing [7]. Many humoral and cellular mediators including leukocytes, the coagulation, and complement cascades strictly regulate these processes. However, sometimes these processes become dysregulated and severe immune mediated complications can occu
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