Neutrophil biomarkers after trauma : A first step towards immune-based decision making

Abstract

About halve of the severely injured (polytrauma) patients develop an infectious complication during hospital admission. Such an infection can cause organ failure and sometimes even death in these patients. The neutrophil (white blood cell) is programmed to prevent the patient from developing such life-threatening infections. Also, it plays an important role in the repair of tissue damage. In this thesis we investigated neutrophil biomarkers that can be used to analyze the immune system after trauma. This aids to gain insight in which polytrauma patients develop an infection and when patients develop these infections. These “high risk” patients are likely to benefit from preventive antibiotics and damage control surgery. This latter is a surgical strategy in which only the most necessary procedures are performed immediately and other procedures are postponed until patients are not at risk for infections anymore. Currently, these decisions and timing of these measures are up to the judgement of the treating surgeon. However, the surgeon is only able to make a rough estimate of the patients’ immune system, since every polytrauma patient reacts differently to injury. The immune system can also be measured now by analyzing neutrophil biomarkers: “immunemonitoring”. Using immunemonitoring to make immune related decisions after trauma, “immune-based decision making” could be a first step towards personalized treatment of polytrauma patients.