Leukocytosis as Prognostic Factor for Severe Multiple Injuries
Keywords:
multiple injured patient, leukocytosis, white blood cell count =WBC, ICU, wardAbstract
Objective: The objective of this study was to determine if the white blood cell (WBC) count can predict severity of injuries and can be considered as a bad prognostic sign in multiple injured patients. Methods: This was a comparative study comparing two groups of multiple injured patients according to the severity of injury, intensive care unit (ICU) admitted group with severe injuries and ward admitted one without significant injuries, and comparing their initial WBC in the first day. Also, the ICU admitted group was divided into two subgroups, survived and died one, comparing the decline in WBC count between them in the first 3 days. Results: There was a difference in mean WBC count between ICU group with severe injuries and ward one without significant injury that was statistically significant (p<0.0001). Also there was a significant resistance of WBCs to decline to normal level in the died ICU subgroup as survived patients in the first three days (p<0.0001, p<0.0001 and p<0.0001 respectively). Conclusion: A significant elevation in WBC count in severe multiple injured patients is found and it can be considered as a bad prognostic sign for those with slow decline to normal level within first three days.References
Brown CV, Velmahos GC, Neville AL, et al. Hemodynamically ”stable” patients with peritonitis after penetrating abdominal trauma: identifying those who are bleeding. Arch Surg. 2005; 140:767–72. [PubMed]
Adams SL, Greene JS. Absence of a tachycardic response to intraperitoneal hemorrhage. J Emerg Med. 1986;4:383–9. [PubMed]
Thompson D, Adams SL, Barrett J. Relative bradycardia in patients with isolated penetrating abdominal trauma and isolated extremity trauma. Ann Emerg Med. 1990;19:268–75. [PubMed]
Lipsky AM, Gausche-Hill M, Henneman PL, et al. Prehospital hypotension is a predictor of the need for an emergent, therapeutic operation in trauma patients with normal systolic blood pressure in the emergency department. J Trauma. 2006;61:1228–33. [PubMed]
Toft P, Helbo-Hansen HS, Tonnesen E, et al. Redistribution of granulocytes during adrenaline infusion and following administration of cortisol in healthy volunteers. Acta Anaesthesiol Scand.1994;38:254–8. [PubMed]
Landmann R, Durig M, Gudat F, et al. Beta-adrenergic regulation of the blood lymphocyte phenotype distribution in normal subjects and splenectomized patients. Adv Exp Med Biol.1985;186:1051–62. [PubMed]
Bessey PQ, Watters JM, Aoki TT, et al. Combined hormonal infusion simulates the metabolic response to injury. Ann Surg. 1984;200:264–81. [PMC free article] [PubMed]
Dietrich WD, Chatzipanteli K, Vitarbo E, Wada K, Kinoshita K: The role of inflammatory processes in the pathophysiology and treatment of brain and spinal cord trauma. Acta Neurochir Suppl 89: 69-74, 2004.
Fee D, Crumbaugh A, Jacques T, Herdrich B, Sewell D, Auerbach D, Piaskowski S, Hart MN, Sandor M, Fabry Z: Activated/effector CD4+ T cells exacerbate acute damage in the central nervous system following traumatic injury. J Neuroimmunol 136: 54-66, 2003.
Gourin CG, Shackford SR.: Production of tumor necrosis factor-alpha and interleukin-l beta by human cerebral microvascular endothelium after percussive trauma. J Trauma 42:1101-1107,1997.
Juurlink BH: Introduction: The role of inflammation in mediating damage following stroke and neurotrauma. Brain Pathol 10: 93-94, 2000.
Lenzlinger PM, Hans VH, Joller-Jemelka HI, Trentz O, Morganti¬Kossmann MC, Kossmann T: Markers for cell-mediated immune response are elevated in cerebrospinal fluid and serum after severe traumatic brain injury in humans. J Neurotrauma 18: 479--489 30, 2001.
Morell V, Lundgren E, Gillott A. Predicting severity of trauma by admission white blood cell count, serum potassium level, and arterial pH. South Med J. 1993;86(6):658–9. [PubMed]
Santucci CA, Purcell TB, Mejia C. Leukocytosis as a predictor of severe injury in blunt trauma. West J Emerg Med. 2008;9:81–5. [PMC free article] [PubMed]
Holmes JF, Sokolove PE, Land C, et al. Identification of intraabdominal injuries in children hospitalized following blunt torso trauma. Acad Emerg Med. 1999;6:799–806. [PubMed]
Lorenzo Paladino, MD, Ramanand A. Subramanian, PhD, Elisabeth Bonilla, BS, and Richard H. Sinert, DO. Leukocytosis as Prognostic Indicator of Major Injury. Received December 10, 2009; Revised February 16, 2010; Accepted April 21, 2010.
Rovlias A, Kotsou S. The blood leukocyte count and its prognostic significance in severe head injury.Surg Neurol. 2001;55:190–6. [PubMed]
Boggs DR: The kinetics of neutrophilic leukocytes in health and in disease. Semins Hemat 4:359-386, 1967.
Capps JA: Astudy of the blood in general paralysis. Am J Med Sci 3:650-682, 1896 (cited in 1).
Clifton GL, Ziegler MG, Grossman RG: Circulating catecholamines and sympathetic activity after head injury. Neurosurgery 8:10-14,1981.
Czigner A, Mihaly A, Farkas O, Büki A, Krisztin-Peva B, Dobo E, Barzo P: Kinetics of the cellular immune response following closed head injury. Acta Neurochir (Wien) 149:281-289, 2007.
Dale DC: Leukocytosis, leukopenia, and eosinophilia. In: Harrison's, ed. Principles of Internal Medicine. New York: McGraw-Hill, Inc., 1991:359-362
Hallznbeck J, Dutka A, Tanishima T, Kochanek P, Kumaroo K, Thompson C, Obrenovitch T, Contrzras T: Polymorphonuclear leukocyte accumulation in brain regions with low blood flow during the early post-ischemic period. Stroke 17: 246-253, 1986
Janoff A, Schaeffer S, Scherer J. Bean MA: Mediators in inflammation in leukocyte lysosomes. Mechanism of action of lysosomal cationic protein upon vascular permeability in the rat. J Exp Med 132: 841-851, 1965.
Suval WD, Duran WN, Boric VIP, Hobson RV. Berendson PB. Ritter AB: Microvascular transport and endothelial cell alterations preceding skeletal muscle damage in ischernia and reperfusion injury. Am J Surg 154: 211-215, 1987.
Yamakawa T, Yamaguchi S, Niimi H. Sugiyama I: WBC plugging and blood flow maldistribution, in the capillary network of cat cerebral cortex in acute hemorrhagic
hypotension: An intra-vital microscopic study. Circ Shock 22: 323-332, 1987.
Harlan JM: Leucocyte endothelial interactions. Blood 65: 513-525,1985.
Akköse S, Bulut M, Erol A, Veysel B, et al. Does the leukocyte count correlate with the severity of injury? Turkish Journal of Trauma and Emergency Surgery. 2003;9:111–113. [PubMed]
Harris HW, Morabito DJ, Mackersie RC, Halvorsen RA, et al. Leukocytosis and free fluid are important indicators of isolated intestinal injury after blunt trauma. J Trauma. 1999;46:656–659. [PubMed]
Gürkanlar, Predictive Value of Leukocytosis in Head Trauma. Turkish Neurosurgery 2009, Vol: 19, No: 3, 211-215
