Splenectomy is associated with altered leukocyte kinetics after severe trauma

Michel Paul Johan Teuben,Taco Blokhuis,Arne Hollman,Roy Spijkerman,Hans-Christoph Pape,Luke Petrus Hendrikus Leenen,Henrik Teuber,Roman Pfeifer

doi:10.1186/s40001-021-00497-8

Abstract

BackgroundInadequate activation of the innate immune system after trauma can lead to severe complications such as Acute Respiratory Distress Syndrome and Multiple Organ Dysfunction Syndrome. The spleen is thought to modulate the cellular immune system. Furthermore, splenectomy is associated with improved outcome in severely injured trauma patients. We hypothesized that a splenectomy alters the cellular immune response in polytrauma.MethodsAll adult patients with an ISS ≥ 16 and suffering from splenic or hepatic injuries were selected from our prospective trauma database. Absolute leukocyte numbers in peripheral blood were measured. White blood cell kinetics during the first 14 days were compared between splenectomized patients, patients treated surgically for liver trauma and nonoperatively treated individuals.ResultsA total of 129 patients with a mean ISS of 29 were included. Admission characteristics and leukocyte numbers were similar in all groups, except for slightly impaired hemodynamic status in patients with operatively treated liver injuries. On admission, leukocytosis occurred in all groups. During the first 24 h, leukopenia developed gradually, although significantly faster in the operatively treated patients. Thereafter, leukocyte levels normalized in all nonoperatively treated cases whereas leukocytosis persisted in operatively treated patients. This effect was significantly more prominent in splenectomized patients than all other conditions.ConclusionsThis study demonstrates that surgery for intra-abdominal injuries is associated with an early drop in leucocyte numbers in peripheral blood. Moreover, splenectomy in severely injured patients is associated with an altered cellular immune response reflected by a persistent state of prominent leukocytosis after trauma.

Highlights

Inadequate activation of the innate immune system after trauma can lead to severe complications such as Acute Respiratory Distress Syndrome and Multiple Organ Dysfunction Syndrome
We identified a persistent state of leukocytosis in splenectomized polytrauma patients which may be the result of decreased neutrophil apoptosis as a consequence of asplenia, and subsequent prolonged survival of competent immune cells incapable of extravasating into tissue compartments [29,30,31,32]
Should not be considered as an essential confounding factor as well. More studies on this issue in blunt abdominal organ injuries are indicated. This is the first human study to demonstrate that splenectomy is associated with altered post-insult leukocyte kinetics in peripheral blood of trauma patients

Summary

Introduction

Inadequate activation of the innate immune system after trauma can lead to severe complications such as Acute Respiratory Distress Syndrome and Multiple Organ Dysfunction Syndrome. We hypothesized that a splenectomy alters the cellular immune response in polytrauma. Trauma activates the innate immune system [1,2,3]. Extensive tissue damage in severe trauma evokes systemic inflammation and initiates a clinical condition known as Systematic Inflammatory Response Syndrome (SIRS) [4, 5]. It has been demonstrated that excessive PMN tissue influx is associated with the occurrence of early Acute Respiratory Distress Syndrome (ARDS) or Multiple Organ Dysfunction Syndrome (MODS) after trauma. Excessive immune activation is a risk factor for late septic complications after trauma [1, 7]. The inflammatory response to trauma has a bimodal pattern in which a pro-inflammatory phase is followed by an anti-inflammatory phase, genetic studies suggest that both pro- and anti-inflammatory pathways

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Discussion

Conclusion