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Deep immune profiling of whole blood to identify early immune signatures that correlate to patient outcome after major trauma.
- Source :
-
The journal of trauma and acute care surgery [J Trauma Acute Care Surg] 2021 Jun 01; Vol. 90 (6), pp. 959-966. - Publication Year :
- 2021
-
Abstract
- Background: Major injury results in an early cascade of immunologic responses that increase susceptibility to infection and multiorgan dysfunction. Detailed immune profiling by mass cytometry has the potential to identify immune signatures that correspond to patient outcomes. Our objective was to determine the prognostic value of immune signatures early after major trauma injury.<br />Methods: Trauma patients (n = 17) were prospectively enrolled between September 2018 and December 2019. Serial whole blood samples were obtained from trauma patients (mean Injury Severity Score, 26.2; standard error of the mean, 3.7) at Days 1 and 3 after injury, and from age- and sex-matched uninjured controls using a standardized protocol for fixation, storage, and labeling. Computational analyses including K-nearest neighbor automated clustering of immune cells and Spearman's correlation analysis were used to identify correlations between cell populations, clinical measures, and patient outcomes.<br />Results: Analysis revealed nine immune cell clusters that correlated with one or more clinical outcomes. On Days 1 and 3 postinjury, the abundance of immature neutrophil and classical monocytes exhibited a strong positive correlation with increased intensive care unit and hospital length of stay. Conversely, the abundance of CD4 T-cell subsets, namely Th17 cells, is associated with improved patient outcomes including decreased ventilator days (r = -0.76), hospital-acquired pneumonia (r = -0.69), and acute kidney injury (r = -0.73).<br />Conclusion: Here, we provide a comprehensive multitime point immunophenotyping analysis of whole blood from patients soon after traumatic injury to determine immune correlates of adverse outcomes. Our findings indicate that alterations in myeloid-origin cell types may contribute to immune dysfunction after injury. Conversely, the presence of effector T cell populations corresponds with decreased hospital length of stay and organ dysfunction. Overall, these data identify novel immune signatures following traumatic injury that support the view that monitoring of immune (sub)-populations may provide clinical decision-making support for at-risk patients early in their hospital course.<br />Level of Evidence: Prognostic/Epidemiologic, Level IV.<br /> (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)
- Subjects :
- Acute Kidney Injury blood
Acute Kidney Injury immunology
Acute Kidney Injury prevention & control
Adult
Case-Control Studies
Clinical Decision-Making methods
Critical Illness
Female
Healthcare-Associated Pneumonia blood
Healthcare-Associated Pneumonia immunology
Healthcare-Associated Pneumonia prevention & control
Humans
Injury Severity Score
Intensive Care Units statistics & numerical data
Length of Stay statistics & numerical data
Male
Middle Aged
Prospective Studies
Risk Assessment methods
Wounds and Injuries complications
Wounds and Injuries diagnosis
Wounds and Injuries immunology
Acute Kidney Injury epidemiology
Healthcare-Associated Pneumonia epidemiology
Immunophenotyping methods
Wounds and Injuries blood
Subjects
Details
- Language :
- English
- ISSN :
- 2163-0763
- Volume :
- 90
- Issue :
- 6
- Database :
- MEDLINE
- Journal :
- The journal of trauma and acute care surgery
- Publication Type :
- Academic Journal
- Accession number :
- 33755643
- Full Text :
- https://doi.org/10.1097/TA.0000000000003170