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Article |

Posttraumatic Auto-oxidative Polymorphonuclear Neutrophil Receptor Injury Predicts the Development of Nosocomial Infection

H. Hank Simms, MD; Ronald D'Amico
Arch Surg. 1997;132(2):171-177. doi:10.1001/archsurg.1997.01430260069016.
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Objective:  To determine the mechanisms and prevalence of posttraumatic auto-oxidative receptor injury and immune suppression to subsequent nosocomial infections.

Design:  Purified polymorphonuclear neutrophils from 30 critically ill trauma patients (mean [±SD] Injury Severity Scores, 21.5±7.3) were incubated with glucose and glucose-oxidase to generate superoxide anion. Subcellular fractionations were performed with iodine I 125 monoclonal antibodies against the Fc receptors CD32w and CD16 and complement receptors CD35 and CD11b/CD18. Plasma membrane expression of these receptors was then determined during the first week of hospitalization.

Setting:  Surgical intensive care unit in a university-affiliated hospital.

Results:  Twenty-three (77%) of 30 patients had persistent auto-oxidative reduction in Fc and complement receptors induced by glucose and glucose-oxidase. Nosocomial infections occurred in 20 (87%) of 23 patients with auto-oxidative injury vs 1 (14%) of 7 patients without auto-oxidative receptor injury (P<.01, unpaired t test). Patients without auto-oxidative injury had expression for each receptor no different from buffer control.

Conclusions:  Critically ill trauma patients have auto-oxidative receptor injury, which is closely linked with the development of nosocomial infections. These results provide a biological basis for the early use of auto-oxidants in critically ill trauma patients.Arch Surg. 1997;132:171-177


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