Changes in blood lymphocyte populations after multiple trauma: association with posttraumatic complications

Crit Care Med. 1999 Apr;27(4):733-40. doi: 10.1097/00003246-199904000-00026.


Objective: To study the frequency of several lymphocyte subsets, circulating cytokines, and prostaglandin plasma values at their time course over a period of 14 days in severely injured trauma patients in relation to the development of sepsis and multiple organ failure (MOF).

Design: Prospective study.

Setting: An operative intensive care unit (ICU) of a university hospital.

Patients: Sixty-eight consecutive severely injured trauma patients.

Interventions: Patients were separated into patients without sepsis and MOF (group 1, n = 51), and patients who developed sepsis and MOF (group 2, n = 17) during their stay in the ICU. Therapy was adjusted to the standards of modern intensive care management by physicians who were not involved in the study.

Measurements and main results: In arterial blood samples, the profile of lymphocyte subset frequencies was performed by flow cytometry and, together with interleukin (IL)-1, IL-10, tumor necrosis factor (TNF)-alpha soluble TNF-alpha receptor 1 (sTNF-alpha r1 [p55]), and prostaglandin E2 (PGE2alpha)-alpha, serially measured after arrival in the ICU (baseline value) and during the next 14 days. Mean plasma IL-1 (29.3 +/- 5.8 [SD] pg/mL), TNF-alpha (138.5 +/- 22.4 pg/mL), and soluble TNF-alpha r1 (6.1 +/- 0.3 ng/mL) values were significantly higher in group 2 patients before clinical evidence of sepsis and MOF. With the onset of severe infections in group 2 patients, IL-1, TNF-alpha, and sTNF-alpha r1 values decreased, while immunosuppressive IL-10 (191.7 +/- 29.1 pg/mL) and PGE2alpha (87.7 +/- 20.4 pg/mL) values further increased and remained elevated during the time course. Analysis of lymphocyte subsets revealed a fall in total lymphocyte levels, in CD4+ T lymphocytes, and natural killer (NK) cells, but no change in CD8+ T lymphocyte subset. Despite a marked change in the T helper (CD4+) to T suppressor (CD8+) ratio (from 1:1.72 to 1:1.10), patients without MOF (group 1) had no significant difference in any of the markers tested compared with baseline values. In addition to the inverse CD4+/CD8+ T cell ratio (from 1:1.75 to 1:0.91) and increased activated T cells, each of these markers was significantly elevated and peaked before the onset of MOF in group 2 patients.

Conclusions: A severely depressed cellular immune response associated with increased suppressive mediators might be closely related to the development of severe sepsis and MOF in trauma patients. Therefore, an in-depth understanding of the deficits in host defense following multiple trauma will provide the basis for therapeutic interventions.

MeSH terms

  • Adult
  • Cytokines / blood*
  • Flow Cytometry
  • Humans
  • Immune Tolerance / immunology*
  • Lymphocyte Count
  • Lymphocyte Subsets / immunology*
  • Middle Aged
  • Multiple Organ Failure / classification
  • Multiple Organ Failure / diagnosis
  • Multiple Organ Failure / etiology*
  • Multiple Trauma / blood
  • Multiple Trauma / complications*
  • Multiple Trauma / immunology*
  • Prospective Studies
  • Prostaglandins / blood*
  • Sepsis / etiology*
  • Severity of Illness Index
  • Time Factors


  • Cytokines
  • Prostaglandins