eISSN: 1644-4124
ISSN: 1426-3912
Central European Journal of Immunology
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4/2013
vol. 38
 
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abstract:

Looking for the immunological “time window” for the surgical intervention in patients with polytrauma

Wojciech Marks
,
Katarzyna Gołąbek-Dropiewska
,
Ewa Bryl
,
Zbigniew Witkowski
,
Jerzy Lasek
,
Justyna Pawłowska
,
Agnieszka Jóźwik
,
Jan Wieruszewski
,
Robert Dudek
,
Jacek Witkowski

(Centr Eur J Immunol 2013; 38 (4): 530-536)
DOI: https://doi.org/10.5114/ceji.2013.39771
Online publish date: 2013/12/30
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Background: Polytrauma patients with a severity score over 16 points are at a risk of development of immunologically derived complications (infection, “2nd-hit injuries”). The aim of this study is to evaluate the phagocytic arm of the immune system in patients with polytrauma during a period of time, which is critical for therapeutic decisions. The phagocytic arm is analyzed to optimize the timing of definitive surgery.

Material and methods: The study group consisted of 7 men and 5 women from 20 to 84 years of age who had sustained a polytrauma as a result of mechanical factors. Polytrauma was severe (over 16 points ISS – Injury Severity Score) in all of the cases. All patients were studied on the 3rd and 6th day after trauma. Nine CNS-injured patients (isolated injury) and eleven healthy age- and sex-matched volunteers served as controls.

Results: A statistically significant and higher individual cellular phagocytic activity (number

of bacteria per cell) was observed in polytrauma patients on the 3rd day when compared to CNS-injured patients. The percentages of granulocytes showing phagocytosis in polytrauma patients on the 3rd and 6th day were significantly lower when compared to CNS-injured patients and healthy controls.

The percentages of granulocytes showing enzymatic activity in polytrauma patients on the 3rd and 6th day were significantly lower comparing to CNS-injured patients and healthy controls. Statistically significant and higher enzymatic activity of granulocytes was observed on the 3rd and 6th day in polytrauma patients when compared to healthy controls.

Conclusions: A significant deficiency of the phagocytic arm was observed during a period of time, which is critical for definitive surgical interventions in polytrauma patients. The phagocytic arm should be analyzed to optimize the timing of definitive surgery.
keywords:

polytrauma, immunology, CNS injury, timing of definitive surgery, flow cytometry, phagocytosis, and oxygen burst
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