Biomarkers to Guide the Timing of Surgery: Neutrophil and Monocyte L-Selectin Predict Postoperative Sepsis in Orthopaedic Trauma Patients
Deciding whether to delay non-lifesaving orthopaedic trauma surgery to prevent multiple organ failure (MOF) or sepsis is frequently disputed and largely based on expert opinion. We hypothesise that neutrophils and monocytes differentially express activation markers prior to patients developing these...
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doaj-540419c69e004f30b799b96b6b50261f2021-06-01T00:32:42ZengMDPI AGJournal of Clinical Medicine2077-03832021-05-01102207220710.3390/jcm10102207Biomarkers to Guide the Timing of Surgery: Neutrophil and Monocyte L-Selectin Predict Postoperative Sepsis in Orthopaedic Trauma PatientsGabrielle Daisy Briggs0Karla Lemmert1Natalie Jane Lott2Theo de Malmanche3Zsolt Janos Balogh4School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308, AustraliaImmunlogy Department, Hunter Area Pathology Service, John Hunter Hospital, New Lambton Heights, NSW 2305, AustraliaTrauma Service, John Hunter Hospital, New Lambton Heights, NSW 2305, AustraliaImmunlogy Department, Hunter Area Pathology Service, John Hunter Hospital, New Lambton Heights, NSW 2305, AustraliaSchool of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308, AustraliaDeciding whether to delay non-lifesaving orthopaedic trauma surgery to prevent multiple organ failure (MOF) or sepsis is frequently disputed and largely based on expert opinion. We hypothesise that neutrophils and monocytes differentially express activation markers prior to patients developing these complications. Peripheral blood from 20 healthy controls and 162 patients requiring major orthopaedic intervention was collected perioperatively. Neutrophil and monocyte L-selectin, CD64, CD11, CD18, and CXCR1 expression were measured using flow cytometry. The predictive ability for MOF and sepsis was assessed using the Receiver Operating Characteristic (ROC) comparing to C-reactive protein (CRP). Neutrophil and monocyte L-selectin were significantly higher in patients who developed sepsis. Neutrophil L-selectin (AUC 0.692 [95%CI 0.574–0.810]) and monocyte L-selectin (AUC 0.761 [95%CI 0.632–0.891]) were significant predictors of sepsis and were not significantly different to CRP (AUC 0.772 [95%CI 0.650–0.853]). Monocyte L-selectin was predictive of MOF preoperatively and postoperatively (preop AUC 0.790 [95%CI 0.622–0.958]). CD64 and CRP were predictive of MOF at one-day postop (AUC 0.808 [95%CI 0.643–0.974] and AUC 0.809 [95%CI 0.662–0.956], respectively). In the perioperative period, elevated neutrophil and monocyte L-selectin are predictors of postoperative sepsis. Larger validation studies should focus on these biomarkers for deciding the timing of long bone/pelvic fracture fixation.https://www.mdpi.com/2077-0383/10/10/2207L-selectinsepsisSIRSmultiple organ failuretrauma |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Gabrielle Daisy Briggs Karla Lemmert Natalie Jane Lott Theo de Malmanche Zsolt Janos Balogh |
spellingShingle |
Gabrielle Daisy Briggs Karla Lemmert Natalie Jane Lott Theo de Malmanche Zsolt Janos Balogh Biomarkers to Guide the Timing of Surgery: Neutrophil and Monocyte L-Selectin Predict Postoperative Sepsis in Orthopaedic Trauma Patients Journal of Clinical Medicine L-selectin sepsis SIRS multiple organ failure trauma |
author_facet |
Gabrielle Daisy Briggs Karla Lemmert Natalie Jane Lott Theo de Malmanche Zsolt Janos Balogh |
author_sort |
Gabrielle Daisy Briggs |
title |
Biomarkers to Guide the Timing of Surgery: Neutrophil and Monocyte L-Selectin Predict Postoperative Sepsis in Orthopaedic Trauma Patients |
title_short |
Biomarkers to Guide the Timing of Surgery: Neutrophil and Monocyte L-Selectin Predict Postoperative Sepsis in Orthopaedic Trauma Patients |
title_full |
Biomarkers to Guide the Timing of Surgery: Neutrophil and Monocyte L-Selectin Predict Postoperative Sepsis in Orthopaedic Trauma Patients |
title_fullStr |
Biomarkers to Guide the Timing of Surgery: Neutrophil and Monocyte L-Selectin Predict Postoperative Sepsis in Orthopaedic Trauma Patients |
title_full_unstemmed |
Biomarkers to Guide the Timing of Surgery: Neutrophil and Monocyte L-Selectin Predict Postoperative Sepsis in Orthopaedic Trauma Patients |
title_sort |
biomarkers to guide the timing of surgery: neutrophil and monocyte l-selectin predict postoperative sepsis in orthopaedic trauma patients |
publisher |
MDPI AG |
series |
Journal of Clinical Medicine |
issn |
2077-0383 |
publishDate |
2021-05-01 |
description |
Deciding whether to delay non-lifesaving orthopaedic trauma surgery to prevent multiple organ failure (MOF) or sepsis is frequently disputed and largely based on expert opinion. We hypothesise that neutrophils and monocytes differentially express activation markers prior to patients developing these complications. Peripheral blood from 20 healthy controls and 162 patients requiring major orthopaedic intervention was collected perioperatively. Neutrophil and monocyte L-selectin, CD64, CD11, CD18, and CXCR1 expression were measured using flow cytometry. The predictive ability for MOF and sepsis was assessed using the Receiver Operating Characteristic (ROC) comparing to C-reactive protein (CRP). Neutrophil and monocyte L-selectin were significantly higher in patients who developed sepsis. Neutrophil L-selectin (AUC 0.692 [95%CI 0.574–0.810]) and monocyte L-selectin (AUC 0.761 [95%CI 0.632–0.891]) were significant predictors of sepsis and were not significantly different to CRP (AUC 0.772 [95%CI 0.650–0.853]). Monocyte L-selectin was predictive of MOF preoperatively and postoperatively (preop AUC 0.790 [95%CI 0.622–0.958]). CD64 and CRP were predictive of MOF at one-day postop (AUC 0.808 [95%CI 0.643–0.974] and AUC 0.809 [95%CI 0.662–0.956], respectively). In the perioperative period, elevated neutrophil and monocyte L-selectin are predictors of postoperative sepsis. Larger validation studies should focus on these biomarkers for deciding the timing of long bone/pelvic fracture fixation. |
topic |
L-selectin sepsis SIRS multiple organ failure trauma |
url |
https://www.mdpi.com/2077-0383/10/10/2207 |
work_keys_str_mv |
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