Biomarkers to Guide the Timing of Surgery: Neutrophil and Monocyte L-Selectin Predict Postoperative Sepsis in Orthopaedic Trauma Patients.

Gabrielle Daisy Briggs,Karla Lemmert,Zsolt Janos Balogh,Natalie Jane Lott,Theo De Malmanche

doi:10.3390/jcm10102207

Gabrielle Daisy Briggs, Karla Lemmert + Show 3 more

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https://doi.org/10.3390/jcm10102207

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Abstract

Deciding whether to delay non-lifesaving orthopaedic trauma surgery to prevent multiple organ failure (MOF) or sepsis is frequently disputed and largely based on expert opinion. We hypothesise that neutrophils and monocytes differentially express activation markers prior to patients developing these complications. Peripheral blood from 20 healthy controls and 162 patients requiring major orthopaedic intervention was collected perioperatively. Neutrophil and monocyte L-selectin, CD64, CD11, CD18, and CXCR1 expression were measured using flow cytometry. The predictive ability for MOF and sepsis was assessed using the Receiver Operating Characteristic (ROC) comparing to C-reactive protein (CRP). Neutrophil and monocyte L-selectin were significantly higher in patients who developed sepsis. Neutrophil L-selectin (AUC 0.692 [95%CI 0.574–0.810]) and monocyte L-selectin (AUC 0.761 [95%CI 0.632–0.891]) were significant predictors of sepsis and were not significantly different to CRP (AUC 0.772 [95%CI 0.650–0.853]). Monocyte L-selectin was predictive of MOF preoperatively and postoperatively (preop AUC 0.790 [95%CI 0.622–0.958]). CD64 and CRP were predictive of MOF at one-day postop (AUC 0.808 [95%CI 0.643–0.974] and AUC 0.809 [95%CI 0.662–0.956], respectively). In the perioperative period, elevated neutrophil and monocyte L-selectin are predictors of postoperative sepsis. Larger validation studies should focus on these biomarkers for deciding the timing of long bone/pelvic fracture fixation.

Highlights

Modern advances in critical care have greatly improved the survival rates of victims of severe trauma
This study examines the changes in cell surface markers of neutrophil and monocyte activation, namely, L-selectin (CD62L), CD64, CD11b, CD18, and CXCR1 in the perioperative period to definitive orthopaedic surgery, to predict poor outcomes of postoperative sepsis and multiple organ failure (MOF) at a clinically meaningful time point for decision making about planned urgent surgery
Patients with postoperative systemic inflammatory response (SIRS) met the criteria at a median of a 1-day postop, while patients who went on to develop sepsis had SIRS at a median of 1-day postop, but confirmed infection at a median of 5 days postop

Summary

Introduction

Modern advances in critical care have greatly improved the survival rates of victims of severe trauma. For those who survive the initial injuries, multiple organ failure (MOF) remains the leading cause of late post-injury mortality [1]. Less attention is paid to the non-lifesaving major surgical interventions, which are essential for facilitating patient mobility, better positioning, shortening ICU stay, and minimising immobilisation associated complications. These procedures frequently involve the surgical stabilisation of long bones

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