Immunomonitoring in patients with early moderate and severe head trauma

Background: Trauma patients with severe and moderate central nervous system (CNS) injuries are at risk of immunologically derived complications (infection, “2nd-hit injuries”). the aim of this study is to evaluate the phagocytic arm of the immune system in patients with isolated CNS injuries during a period of time which is critical for the incidence of infections. the phagocytic arm is analyzed to optimize the timing of definitive surgery and to introduce the immunomodulation therapy and prophylactic measures. Material and methods: the study group consisted of 7 men and 2 women from 18 to 79 years of age who had sustained an acute, isolated cns injury as a result of mechanical trauma. brain damage was severe or moderate in all of the cases [≤ 11 Glasgow coma scale (Gcs) pts]. all patients were studied on the 3 rd , 6 th and 9 th day after trauma. eleven healthy age- and sex-matched volunteers served as controls. Results: A statistically significantly lower individual cellular phagocytic activity (number of bacteria per cell) was observed in the cns-injured patients on the 3 rd , 6 th and 9 th day. the percentages of granulocytes showing phagocytosis in cns-injured patients on the 3 rd and 9 th day were also significantly lower. a statistically significantly lower enzymatic activity of granulocytes was observed on the 9 th day in cns-injured patients. Conclusions: A significant deficiency of the phagocytic arm was observed during a period of time which is critical for “2nd-hit injuries”. that deficiency played a role in the high rate of infections and multiple organ failure in numerous patients described in the literature.