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Updated: May 13, 2026
Systems Analysis of the Neuroinflammatory and Hemodynamic Response to Traumatic Brain Injury
Published on: May 27, 2022
CD64-Neutrophil expression and stress metabolic patterns in early sepsis and severe traumatic brain injury in
Diana-Michaela Fitrolaki1, Helen Dimitriou, Maria Kalmanti
1Pediatric Intensive Care Unit, University Hospital of Heraklion, 71110 Heraklion, Crete, Greece.
Insights
Children with sepsis exhibit distinct metabolic changes, including high neutrophils expressing CD64, glucose, and triglycerides, alongside low cholesterol and lipoproteins, differing from traumatic brain injury patients. These patterns persist for three days.
Area of Science:
- Pediatric Critical Care Medicine
- Metabolic Disorders in Critical Illness
- Immunology and Flow Cytometry
Background:
- Critical illness causes significant metabolic derangements in children.
- Sepsis and severe traumatic brain injury (TBI) present distinct metabolic profiles.
- Understanding these patterns aids in diagnosing and managing critically ill children.
Purpose of the Study:
- To compare acute phase metabolic patterns in children with sepsis (S), severe sepsis/septic shock (SS), TBI, and healthy controls (C).
- To evaluate the relationship between metabolic patterns and neutrophil, lymphocyte, and monocyte expression of CD64 and CD11b.
- To identify early metabolic markers differentiating sepsis from TBI in critically ill children.
Main Methods:
- Sixty children were studied, including 45 with systemic inflammatory response syndrome (SIRS) divided into TBI, S, and SS groups (n=15 each), and 15 healthy controls (C).
- Flow cytometry assessed CD64 and CD11b expression on immune cells.
- Procalcitonin (PCT), C-reactive protein (CRP), glucose, triglycerides (TG), total cholesterol (TC), HDL, and LDL were measured, with repeat measures in SIRS groups.
Main Results:
- Sepsis groups (S and SS) showed significantly higher CRP, PCT, and TG compared to TBI and C.
- Septic groups had significantly lower TC, LDL, and HDL than C and TBI.
- Increased neutrophil CD64 (nCD64) expression strongly correlated with higher CRP, PCT, glucose, and TG, and lower cholesterol and lipoproteins in sepsis.
Conclusions:
- Sepsis is characterized by a high CD64, glucose, and TG, low cholesterol/lipoprotein metabolic pattern, distinct from TBI.
- These metabolic patterns and associated CD64 expression persist for the first three days of acute illness.
- CD64 expression on neutrophils serves as a marker for the acute phase metabolic derangement in sepsis.
Background:
Critical illness constitutes a serious derangement of metabolism. The aim of our study was to compare acute phase metabolic patterns in children with sepsis (S) or severe sepsis/septic shock (SS) to those with severe traumatic brain injury (TBI) and healthy controls (C) and to evaluate their relations to neutrophil, lymphocyte and monocyte expressions of CD64 and CD11b.
Methods:
Sixty children were enrolled in the study. Forty-five children with systemic inflammatory response syndrome (SIRS) were classified into three groups: TBI (n = 15), S (n = 15), and SS (n = 15). C consisted of 15 non- SIRS patients undergoing screening tests for minor elective surgery. Blood samples were collected within 6 hours after admission for flow cytometry of neutrophil, lymphocyte and monocyte expression of CD64 and CD11b (n = 60). Procalcitonin (PCT), C-reactive protein (CRP), glucose, triglycerides (TG), total cholesterol (TC), high (HDL) or low-density-lipoproteins (LDL) were also determined in all groups, and repeated on day 2 and 3 in the 3 SIRS groups (n = 150).
Results:
CRP, PCT and TG (p < 0.01) were significantly increased in S and SS compared to TBI and C; glucose did not differ among critically ill groups. Significantly lower were the levels of TC, LDL, and HDL in septic groups compared to C and to moderate changes in TBI (p < 0.0001) but only LDL differed between S and SS (p < 0.02). Among septic patients, PCT levels declined significantly (p < 0.02) with time, followed by parallel decrease of HDL (p < 0.03) and increase of TG (p < 0.02) in the SS group. Neutrophil CD64 (nCD64) expression was higher in patients with SS (81.2%) and S (78.8%) as compared to those with TBI (5.5%) or C (0.9%, p < 0.0001). nCD64 was positively related with CRP, PCT, glucose, and TG (p < 0.01) and negatively with TC, LDL, and HDL (p < 0.0001), but not with severity of illness, hematologic indices, length of stay or mechanical ventilation duration.
Conclusions:
In sepsis, the early stress-metabolic pattern is characterized by a high (nCD64, glucose, TG) - low (TC, HDL, LDL) combination in contrast to the moderate pattern of TBI in which only glucose increases combined with a moderate cholesterol - lipoprotein decrease. These early metabolic patterns persist the first 3 days of acute illness and are associated with the acute phase CD64 expression on neutrophils.
