Neutrophil heterogeneity and its role in infectious complications after severe trauma

Lillian Hesselink†Email author View ORCID ID profile,
Roy Spijkerman†,
Karlijn J. P. van Wessem,
Leo Koenderman,
Luke P. H. Leenen,
Markus Huber-Lang and
Falco Hietbrink

†Contributed equally

World Journal of Emergency Surgery201914:24

https://doi.org/10.1186/s13017-019-0244-3

Received: 26 April 2019
Accepted: 13 May 2019
Published: 29 May 2019

Abstract

Background

Trauma leads to a complex inflammatory cascade that induces both immune activation and a refractory immune state in parallel. Although both components are deemed necessary for recovery, the balance is tight and easily lost. Losing the balance can lead to life-threatening infectious complications as well as long-term immunosuppression with recurrent infections. Neutrophils are known to play a key role in these processes. Therefore, this review focuses on neutrophil characteristics and function after trauma and how these features can be used to identify trauma patients at risk for infectious complications.

Results

Distinct neutrophil subtypes exist that play their own role in the recovery and/or development of infectious complications after trauma. Furthermore, the refractory immune state is related to the risk of infectious complications. These findings change the initial concepts of the immune response after trauma and give rise to new biomarkers for monitoring and predicting inflammatory complications in severely injured patients.

Conclusion

For early recognition of patients at risk, the immune system should be monitored. Several neutrophil biomarkers show promising results and analysis of these markers has become accessible to such extent that they can be used for point-of-care decision making after trauma.