New automated analysis to monitor neutrophil function point-of-care in the intensive care unit after trauma

Lillian Hesselink; Roy Spijkerman; Emma de Fraiture; Suzanne Bongers; Karlijn J P Van Wessem; Nienke Vrisekoop; Leo Koenderman; Luke P H Leenen; Falco Hietbrink

doi:10.1186/s40635-020-0299-1

New automated analysis to monitor neutrophil function point-of-care in the intensive care unit after trauma

Intensive Care Med Exp. 2020 Mar 14;8(1):12. doi: 10.1186/s40635-020-0299-1.

Authors

Lillian Hesselink^{1

2

3}, Roy Spijkerman^{4

5}, Emma de Fraiture^{4

5}, Suzanne Bongers^{4

5}, Karlijn J P Van Wessem⁴, Nienke Vrisekoop⁵, Leo Koenderman^{6

5}, Luke P H Leenen⁴, Falco Hietbrink⁴

Affiliations

¹ Department of Trauma Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, the Netherlands. lilianhesselink@gmail.com.
² Center for Translational Immunology, University Medical Center Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, the Netherlands. lilianhesselink@gmail.com.
³ Department of Trauma Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, the Netherlands. lilianhesselink@gmail.com.
⁴ Department of Trauma Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, the Netherlands.
⁵ Center for Translational Immunology, University Medical Center Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, the Netherlands.
⁶ Department of Respiratory Medicine, Wilhelmina Children's Hospital, Lundlaan 6, 3584, EA, Utrecht, the Netherlands.

Abstract

Background: Patients often develop infectious complications after severe trauma. No biomarkers exist that enable early identification of patients who are at risk. Neutrophils are important immune cells that combat these infections by phagocytosis and killing of pathogens. Analysis of neutrophil function used to be laborious and was therefore not applicable in routine diagnostics. Hence, we developed a quick and point-of-care method to assess a critical part of neutrophil function, neutrophil phagosomal acidification. The aim of this study was to investigate whether this method was able to analyze neutrophil functionality in severely injured patients and whether a relation with the development of infectious complications was present.

Results: Fifteen severely injured patients (median ISS of 33) were included, of whom 6 developed an infection between day 4 and day 9 after trauma. The injury severity score did not significantly differ between patients who developed an infection and patients who did not (p = 0.529). Patients who developed an infection showed increased acidification immediately after trauma (p = 0.006) and after 3 days (p = 0.026) and a decrease in the days thereafter to levels in the lower normal range. In contrast, patients who did not develop infectious complications showed high-normal acidification within the first days and increased tasset to identify patients at risk for infections after trauma and to monitor the inflammatory state of these trauma patients.

Conclusion: Neutrophil function can be measured in the ICU setting by rapid point-of-care analysis of phagosomal acidification. This analysis differed between trauma patients who developed infectious complications and trauma patients who did not. Therefore, this assay might prove a valuable asset to identify patients at risk for infections after trauma and to monitor the inflammatory state of these trauma patients.

Trial registration: Central Committee on Research Involving Human Subjects, NL43279.041.13. Registered 14 February 2014. https://www.toetsingonline.nl/to/ccmo_search.nsf/Searchform?OpenForm.

Keywords: Bedside; Infections; Intensive care; Monitoring; Neutrophils; Point-of-care; Trauma.