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. 2023 Apr;49(2):1023-1034.
doi: 10.1007/s00068-022-02134-3. Epub 2022 Nov 8.

Visualization of the inflammatory response to injury by neutrophil phenotype categories : Neutrophil phenotypes after trauma

Emma J de Fraiture  1   2 , Suus H Bongers  3   4 , Bernard N Jukema  5 , Leo Koenderman  5   4 , Nienke Vrisekoop  5   4 , Karlijn J P van Wessem  3 , Luke P H Leenen  3 , Falco Hietbrink  3
Affiliations

Visualization of the inflammatory response to injury by neutrophil phenotype categories : Neutrophil phenotypes after trauma

Emma J de Fraiture et al. Eur J Trauma Emerg Surg. 2023 Apr.

Abstract

Purpose: The risk of infectious complications after trauma is determined by the amount of injury-related tissue damage and the resulting inflammatory response. Recently, it became possible to measure the neutrophil phenotype in a point-of-care setting. The primary goal of this study was to investigate if immunophenotype categories based on visual recognition of neutrophil subsets are applicable to interpret the inflammatory response to trauma. The secondary goal was to correlate these immunophenotype categories with patient characteristics, injury severity and risk of complications.

Methods: A cohort study was conducted with patients presented at a level 1 trauma center with injuries of any severity, who routinely underwent neutrophil phenotyping. Data generated by automated point-of-care flow cytometry were prospectively gathered. Neutrophil phenotypes categories were defined by visual assessment of two-dimensional CD16/CD62L dot plots. All patients were categorized in one of the immunophenotype categories. Thereafter, the categories were validated by multidimensional analysis of neutrophil populations, using FlowSOM. All clinical parameters and endpoints were extracted from the trauma registry.

Results: The study population consisted of 380 patients. Seven distinct immunophenotype Categories (0-6) were defined, that consisted of different neutrophil populations as validated by FlowSOM. Injury severity scores and risk of infectious complications increased with ascending immunophenotype Categories 3-6. Injury severity was similarly low in Categories 0-2.

Conclusion: The distribution of neutrophil subsets that were described in phenotype categories is easily recognizable for clinicians at the bedside. Even more, multidimensional analysis demonstrated these categories to be distinct subsets of neutrophils. Identification of trauma patients at risk for infectious complications by monitoring the immunophenotype category is a further improvement of personalized and point-of-care decision-making in trauma care.

Keywords: Infection; Inflammation; Injury; Neutrophil; Trauma.

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Conflict of interest statement

All authors declare that they have no potential conflict of interest. There are no competing interests (financial or non-financial).

Figures

Fig. 1
Fig. 1
Flowchart of patient inclusion and data processing
Fig. 2
Fig. 2
Representative individual patient samples to illustrate the immunophenotype categories based on the occurrence of subsets of neutrophils in CD16/CD62L dot plots
See this image and copyright information in PMC

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