Direct correlation between injury severity and two markers of the functional status of the immune system

This study was conducted to identify a relationship between anatomical trauma severity and immunologic function. Four milliliters of citrated whole blood (CWB) was obtained from 14 multiply traumatized patients and their Injury Severity Score (ISS) was calculated. Each CWB sample was divided into four 1 ml aliquots with 1 microgram of E. coli endotoxin (ECE) (Difco) being added to the first, 10 micrograms of ECE to the second, 10 micrograms of pokeweed mitogen (PWM) to the third, and 20 microliters of saline to the fourth. Following a 2 hr incubation at 37 degrees C the recalcification time (RT) was determined on a Hepcon-B10. Percent shortening was calculated as the difference in the RT between the stimulated sample and the saline control. There was a significant correlation between ISS and % shortening of the ECE stimulated samples at both concentrations (for 1 microgram ECE r = 0.59, P = 0.02, and for 10 micrograms ECE r = 0.81, P = 0.00025), and also in the PWM sample (R = 0.79, P = 0.00071). This study demonstrates a significant and direct relationship between trauma severity and the patient's monocytes' ability to generate thromboplastin following ECE or PWM stimulation.