Increased apoptosis of peripheral blood neutrophils is associated with reduced incidence of infection in trauma patients with hemorrhagic shock

J Infect. 2013 Jan;66(1):87-94. doi: 10.1016/j.jinf.2012.10.001. Epub 2012 Oct 9.


Objective: We aimed to describe the relationship between early peripheral leukocyte apoptosis and incidence of subsequent infection in trauma patients with hemorrhagic shock (T/HS).

Methods: T/HS patients requiring emergency surgery were prospectively enrolled. Nucleosome ELISA and TUNEL staining were performed on peripheral blood drawn pre-operatively, post-operatively and at 24 h. Subjects were followed for 30 days or until death or hospital discharge to record all episodes of infection.

Results: Forty-one subjects were enrolled. Six died within 24 h of surgery and were not included in the analysis. Nucleosome levels peaked post-operatively and dropped to baseline levels at 24 h (p = 0.03). TUNEL analysis revealed that polymorphonuclear neutrophils (PMNs) accounted for 72% of apoptotic leukocytes; the remaining apoptotic cells were mainly lymphocytes. Increased post-operative leukocyte apoptosis was associated with decreased systemic inflammatory response syndrome (SIRS) severity. Seventeen of the 35 survivors (48.6%) developed infections, while 18 (51.4%) did not. Pre-operative and post-operative nucleosome levels were 2.5 and 3 times higher, respectively, in T/HS patients who did not develop infection compared to those who did. Increased nucleosome levels were associated in particular with protection against sepsis (p=0.03) and multiple infections (p = 0.01).

Conclusion: Peripheral blood PMN apoptosis in the early resuscitative period is associated with decreased incidence of subsequent infection in T/HS patients.

Publication types

  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Abdominal Abscess / blood*
  • Abdominal Abscess / microbiology
  • Adult
  • Apoptosis / physiology*
  • Female
  • Heart Rate / physiology
  • Humans
  • Incidence
  • Linear Models
  • Male
  • Neutrophils / immunology
  • Neutrophils / pathology*
  • Nucleosomes / metabolism
  • Perioperative Period
  • Pneumonia / blood*
  • Pneumonia / microbiology
  • Prospective Studies
  • Randomized Controlled Trials as Topic
  • Sepsis / blood
  • Sepsis / microbiology
  • Shock, Hemorrhagic / blood*
  • Shock, Hemorrhagic / microbiology
  • Statistics, Nonparametric
  • Wounds, Nonpenetrating / blood
  • Wounds, Nonpenetrating / microbiology
  • Wounds, Nonpenetrating / surgery
  • Wounds, Penetrating / blood*
  • Wounds, Penetrating / surgery


  • Nucleosomes