Objective: To investigate whether early numerical and functional changes in circulating neutrophils and expression of neutrophil L-selectin and soluble L-selectin are related to the subsequent development of posttraumatic acute lung injury (ALI), the systemic inflammatory response syndrome, sepsis, and organ failure.
Design: Prospective study of whole blood and plasma samples to assess numerical and functional changes in circulating neutrophils and in soluble L-selectin.
Setting: The emergency department of a university hospital.
Patients: A total of 147 patients admitted to the resuscitation room after trauma were compared with 69 control subjects. Ten patients developed ALI.
Laboratory analysis: Flow cytometry of whole blood and ELISA of plasma.
Results: Total leukocyte and neutrophil counts, expression of L-selectin, and the ratio of neutrophil to plasma L-selectin increased with injury and were highest in those who developed ALI. Soluble L-selectin decreased with injury severity and was lowest in those who developed ALI.
Conclusions: Early changes in the average expression of L-selectin per cell do not correlate with the development of subsequent posttraumatic ALI. However, the development of ALI is related to the total expression of L-selectin in the neutrophil mass, and the most striking association is in those with lower concentrations of plasma L-selectin.