Changes of the Blood Lymphocytes On Severe Trauma Patients in Early Time

Abstract

Purpose: To evaluate the relationship between the change of blood lymphocyte counts in early stages of trauma patients and the secondary tissue injury after trauma. Method: A retrospective study was conduct to include trauma patients with Injury Severity Score(ISS) ≥16 between January 1 st , 2018 and December 31 st , 2019. Lymphocyte counts of each trauma patient were collected and recorded in first 3 hours, 6-12 hours, 24-48 hours, and 49-72 hours after trauma, separately. The degree of secondary on the trauma patients were evaluated according to the results of laboratory tests, the time stay in ICU and received mechanical ventilation, and 28-day outcome. Correlation analysis was performed between lymphocytes change and the score of the secondary tissue injury in severe trauma patients. Results: The lymphocyte count within first 3 hours after trauma was significantly high,the median was 4.03×10 9 /L, then dropped significantly in 6-72 hours after trauma (median: 0.85~0.99×10 9 /L), there was a significant statistical difference between the lymphocyte count within first 3 hours after trauma and that in 6-72 hours（P=0.000). The ratios of the lymphocytes counts in 6-72 hours to that within first 3 hours after trauma were very low, the median value was 0.22-0.27. The results of regression statistical analysis showed that the change of lymphocyte counts significantly associated with the severe degree of secondary injury (P=0.000). The lymphocyte ratio change can be used to predict the possibility of trauma patients secondary severe tissue injury occurred [Area Under the Curve( AUC) on the ratios of the lymphocytes counts in 6-72 hours to that within first 3 hours after trauma was 0.789, 0.840, 0.861, respectively]. The predictive thresholds of lymphocyte ratio of the trauma patients in the study were 0.31 to 0.35, the prediction sensitivity were 78% to 89% and specificity 74% to 84%. The lymphocyte counts there was significant difference between the patients with assessed as serious secondary tissue injury(87cases) and patients without(25 cases), the median value was 0.21-0.24 , 0.38-0.62, respectively , P=0.000. Conclusion: Lymphocytes counts was significantly increased in the trauma patients with ISS score ≥16 within the first 3 hours after trauma, then decreased significantly in 6-72 hours after trauma. The change of lymphocyte count was significant relationship with the degree of secondary tissue injury, that can be used to predict the degree of secondary severe tissue injury occurred by inflammatory reaction in trauma patients.

Potential Immune Indicators for Predicting the Prognosis of COVID-19 and Trauma: Similarities and Disparities

“…It has been shown that lymphocyte counts decrease immediately after trauma in patients compared to the control group (167,209), although significant decreases in the number of lymphocytes between MOF and non-MOF groups appear after day 2 (169). Accordingly, lymphopenia is detectable during days 2 to 7 after trauma in the MOF group.…”