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[Changes in the cell-mediated immune system in post-traumatic sepsis]
M Vinelli1, F Ferrari, V Zanni
1I Servizio di Anestesia e Rianimazione, Ospedale Maggiore C. A. Pizzardi, USL n. 27, Bologna.
Objective:
We studied the alterations of cell-mediated immunity (CMI) in polytrauma patients and its relation with sepsis.
Design:
a prospective study.
Setting:
ICU, Ospedale Maggiore, Bologna (Italy).
Patients:
We included in the study 42 patients with at least two of following criteria: 1) Trauma Score < or = 12; 2) Abbreviated Injury Score > or = 4; 3) Arterial Pressure on admission < or = 80 mmHg; 4) Injury Severity Score > or = 16. CMI examinations were carried out at three different post-traumatic times (T0-T2). Seventeen patients developed a sepsis within the first eight days from admission.
Results:
Sepsis caused a temporary impairment in some lymphocyte subsets at T2. The patients who developed sepsis showed a significant subset percentage difference for CD3, CD3 activated (p < 0.05) and for interleukin-2 receptor (IL-2R) (p < 0.01) in comparison with the non septic group. At T2, the seven septic patients who died, showed a marked depression of IL-2 values (0.37 +/- 0.12 UI/ml) in comparison with the values of septic patients who survived (0.66 +/- 0.25 UI/ml; p < 0.01) and with the group of non septic patients (0.83 +/- 0.5 UI/ml; p < 0.001). Septic patients who had a IL-2 value of 0.45 or lower had a mortality of 75%. IL-2 values showed a specificity of 89% and a sensibility of 75% in predicting mortality in septic trauma patients.
Conclusion:
We believe that in polytrauma patients IL-2 values monitoring could be a reliable index of the disfunction of CMI and that IL-2R sieric levels could be a diagnostic marker of impending sepsis.