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Blood polymorphonuclear leukocyte migration as a predictive marker for infections in severe trauma: comparison with various inflammation parameters

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Abstract

Objective

To assess in patients with multiple trauma the relevance of the following as predictive markers for infections: the inflammation parameters white blood count, body temperature, blood polymorphonuclear leukocyte (PMN) migration; blood levels of C-reactive protein, PMN elastase, procalcitonin, neopterin, interleukin 6, interleukin 8, malondialdehyde, total antioxidative status; the stress parameters cortisol and lactate.

Design

Prospective observational cohort study.

Setting

Intensive Care Unit of a university surgical department.

Patients

Twenty-six patients with multiple trauma of differing severity.

Measurements and results

Trauma severity was estimated by the ISS. PMN migration upon F-Met-Leu-Phe stimulation was determined in fresh whole blood in a ready-for-use, one-way membrane filter assay and evaluated by automated image analysis. The other parameters were measured with commercially available tests. During hospitalization, nine patients developed infections, and 17 patients were free of infection. PMN migration below a critical minimum preceded infections in eight of the infected, but occurred in only three of the non-infected patients (positive/negative predictive values 0.72/0.93; sensitivity/specificity 0.88/0.82; likelihood ratio 5.0). Fever (≥38.0 °C) had predictive values of 0.83/0.80 and a high likelihood ratio of 9.4, but a low sensitivity/specificity of 0.55/0.94. The other parameters were without significance. Procalcitonin, elastase, C-reactive protein, neopterin and lactate correlated positively with the injury severity score.

Conclusion

PMN migration proved to be a highly sensitive predictive marker for infections. The whole-blood PMN migration test may facilitate early aggressive antimicrobial therapy.

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Authors and Affiliations

  1. Institute of Pathophysiology, Karl- Franzens University, Graz, Heinrichstrasse 31, 8010, Graz, Austria

    Gerd Egger

  2. Department of Nuclear Medicine, University Hospital, Graz, 8036, Graz, Austria

    Reingard Aigner

  3. Department of Obstetrics and Gynecology, University Hospital, Graz , 8036, Graz, Austria

    Andreas Glasner

  4. Department of Traumatology, University Hospital, Graz, 8036, Graz, Austria

    Herwig P. Hofer

  5. Department of Internal Medicine, University Hospital, Graz, 8036, Graz, Austria

    Heike Mitterhammer

  6. Institute of Clinical Chemistry and Laboratory Medicine, Karl Franzens University, Graz, 8010, Graz, Austria

    Sieglinde Zelzer

Authors
  1. Gerd Egger
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  2. Reingard Aigner
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  3. Andreas Glasner
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  4. Herwig P. Hofer
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  5. Heike Mitterhammer
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  6. Sieglinde Zelzer
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Corresponding author

Correspondence to Gerd Egger.

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Coauthors are listed in alphabetical order

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Egger, G., Aigner, R., Glasner, A. et al. Blood polymorphonuclear leukocyte migration as a predictive marker for infections in severe trauma: comparison with various inflammation parameters. Intensive Care Med 30, 331–334 (2004). https://doi.org/10.1007/s00134-003-2111-6

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  • DOI: https://doi.org/10.1007/s00134-003-2111-6

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