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dc.contributor.authorManson, J
dc.contributor.authorCole, E
dc.contributor.authorDe'Ath, HD
dc.contributor.authorVulliamy, P
dc.contributor.authorMeier, U
dc.contributor.authorPennington, D
dc.contributor.authorBrohi, K
dc.date.accessioned2016-07-04T11:02:19Z
dc.date.issued2016-06-07
dc.date.issued2016
dc.date.issued2016-06-07
dc.date.submitted2016-07-04T10:18:25.968Z
dc.identifier.other10.1186/s13054-016-1341-2
dc.identifier.urihttp://qmro.qmul.ac.uk/xmlui/handle/123456789/13173
dc.description2016 The Author(s). Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.en_US
dc.description.abstractBACKGROUND: Early survival following severe injury has been improved with refined resuscitation strategies. Multiple organ dysfunction syndrome (MODS) is common among this fragile group of patients leading to prolonged hospital stay and late mortality. MODS after trauma is widely attributed to dysregulated inflammation but the precise mechanics of this response and its influence on organ injury are incompletely understood. This study was conducted to investigate the relationship between early lymphocyte responses and the development of MODS during admission. METHODS: During a 24-month period, trauma patients were recruited from an urban major trauma centre to an ongoing, observational cohort study. Admission blood samples were obtained within 2 h of injury and before in-hospital intervention, including blood transfusion. The study population was predominantly male with a blunt mechanism of injury. Lymphocyte subset populations including T helper, cytotoxic T cells, NK cells and γδ T cells were identified using flow cytometry. Early cytokine release and lymphocyte count during the first 7 days of admission were also examined. RESULTS: This study demonstrated that trauma patients who developed MODS had an increased population of NK dim cells (MODS vs no MODS: 22 % vs 13 %, p < 0.01) and reduced γδ-low T cells (MODS vs no MODS: 0.02 (0.01-0.03) vs 0.09 (0.06-0.12) × 10^9/L, p < 0.01) at admission. Critically injured patients who developed MODS (n = 27) had higher interferon gamma (IFN-γ) concentrations at admission, compared with patients of matched injury severity and shock (n = 60) who did not develop MODS (MODS vs no MODS: 4.1 (1.8-9.0) vs 1.0 (0.6-1.8) pg/ml, p = 0.01). Lymphopenia was observed within 24 h of injury and was persistent in those who developed MODS. Patients with a lymphocyte count of 0.5 × 10(9)/L or less at 48 h, had a 45 % mortality rate. CONCLUSIONS: This study provides evidence of lymphocyte activation within 2 h of injury, as demonstrated by increased NK dim cells, reduced γδ-low T lymphocytes and high blood IFN-γ concentration. These changes are associated with the development of MODS and lymphopenia. The study reveals new opportunities for investigation to characterise the cellular response to trauma and examine its influence on recovery.
dc.description.sponsorshipJM was funded, in part, by the Royal College of Surgeons of England, The Phillip King Charitable Trust Research Fellowship and The National Institute of Health Research (NIHR).en_US
dc.format.extent176 - ?
dc.languageENG
dc.language.isoenen_US
dc.subjectCellular immunity
dc.subjectCytokines
dc.subjectGamma delta T cells
dc.subjectInnate immunity
dc.subjectLymphocytes
dc.subjectLymphopenia
dc.subjectMultiple organ dysfunction syndrome
dc.subjectNatural killer
dc.subjectTrauma
dc.subjectWounds and injuries
dc.titleEarly changes within the lymphocyte population are associated with the development of multiple organ dysfunction syndrome in trauma patients.
dc.typeJournal Article
dc.rights.holder2016 BioMed Central
dc.identifier.doi10.1186/s13054-016-1341-2
dc.relation.isPartOfCrit Care
dc.relation.isPartOfCrit Care
dc.relation.isPartOfCrit Care
pubs.author-urlhttp://www.ncbi.nlm.nih.gov/pubmed/27268230
pubs.issue1
pubs.organisational-group/Queen Mary University of London
pubs.organisational-group/Queen Mary University of London/Faculty of Medicine & Dentistry
pubs.organisational-group/Queen Mary University of London/Faculty of Medicine & Dentistry/Blizard Institute
pubs.organisational-group/Queen Mary University of London/Faculty of Medicine & Dentistry/Blizard Institute/Immunology and Infectious Disease
pubs.organisational-group/Queen Mary University of London/Faculty of Medicine & Dentistry/Blizard Institute/Neuroscience and Trauma
pubs.publication-statusPublished online
pubs.volume20


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