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Letter

CD4+ T-lymphocyte alterations in trauma patients

Aurélie Gouel-Chéron12, Fabienne Venet23, Bernard Allaouchiche12 and Guillaume Monneret23*

Author Affiliations

1 Hospices Civils de Lyon, Hôpital Edouard Herriot, Service de réanimation, Place d'Arsonval, 69437 Lyon, France

2 Hospices Civils de Lyon/Université Lyon I, EAM 4174, 69008 Lyon, France

3 Hospices Civils de Lyon, Hôpital Edouard Herriot, Laboratoire d'Immunologie, Place d'Arsonval, 69437 Lyon, France

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Critical Care 2012, 16:432  doi:10.1186/cc11376


See related research by Heffernan et al., http://ccforum.com/content/16/1/R12

The electronic version of this article is the complete one and can be found online at: http://ccforum.com/content/16/3/432


Published:26 June 2012

© 2012 BioMed Central Ltd

Letter

We read with great interest the article by Heffernan and colleagues reporting an association between persistent lymphopaenia and increasing mortality in trauma patients [1]. We would like to provide some additional data obtained in a similar cohort of patients.

In parallel with a study recently published in Critical Care in which mHLA-DR expression was assessed [2], we evaluated the CD4+ lymphocyte count and the percentage of CD4+CD25+ regulatory T cells in trauma patients. Sixty-five patients were included (mean ± standard deviation): age 41 ± 18 years, Simplified Acute Physiology Score II 45 ± 16, and Injury Severity Score 38 ± 10. Of these patients, 21 developed sepsis (mainly pneumonia - median delay 4 days) and two died of septic shock. Importantly, 3 days after trauma the patients presented with significant CD4+ lymphocyte alterations: a significantly decreased CD4+ T-cell count and an increased regulatory T-cell percentage (versus control values, P <0.0001; Table 1). Interestingly, we observed a trend toward lower CD4+ T-cell values in patients presenting with secondary infections versus non-infected individuals (343 cells/μl vs. 454 cells/μl, respectively).

Table 1. Trauma patients' immunological characteristics

Our results reinforce the observations made by Heffernan and colleagues [1]. We confirm here that trauma patients exhibit CD4+ T-cell loss with a relative increase in regulatory T-cell values - both parameters associated with unfavourable outcomes after septic shock [3]. Collectively, these data suggest that, in addition to monocyte anergy [2], lymphocyte alterations should be taken into account in the monitoring of trauma patients. Lymphocyte subset counts and phenotyping deserve to be investigated in large cohorts of trauma patients to minutely delineate association with specific clinical outcomes.

Abbreviations

mHLA-DR: monocytic Human Leukocyte Antigen DR.

Competing interests

The authors declare that they have no competing interests.

References

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    Crit Care 2012, 16:R12. PubMed Abstract | BioMed Central Full Text OpenURL

  2. Cheron A, Floccard B, Allaouchiche B, Guignant C, Poitevin F, Malcus C, Crozon J, Faure A, Guillaume C, Marcotte G, Vulliez A, Monneuse O, Monneret G: Lack of recovery in monocyte human leukocyte antigen-DR expression is independently associated with the development of sepsis after major trauma.

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    Clin Chem 2005, 51:2341-2347. PubMed Abstract | Publisher Full Text OpenURL