Early role of neutrophil L-selectin in posttraumatic acute lung injury

To investigate whether early numerical and functional changes in circulating neutrophils and expression of neutrophil L-selectin and soluble L-selectin are related to the subsequent development of posttraumatic acute lung injury (ALI), the systemic inflammatory response syndrome, sepsis, and organ failure.

Prospective study of whole blood and plasma samples to assess numerical and functional changes in circulating neutrophils and in soluble L-selectin.

The emergency department of a university hospital.

A total of 147 patients admitted to the resuscitation room after trauma were compared with 69 control subjects. Ten patients developed ALI.

Flow cytometry of whole blood and ELISA of plasma.

Total leukocyte and neutrophil counts, expression of L-selectin, and the ratio of neutrophil to plasma L-selectin increased with injury and were highest in those who developed ALI. Soluble L-selectin decreased with injury severity and was lowest in those who developed ALI.

Early changes in the average expression of L-selectin per cell do not correlate with the development of subsequent posttraumatic ALI. However, the development of ALI is related to the total expression of L-selectin in the neutrophil mass, and the most striking association is in those with lower concentrations of plasma L-selectin.