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  • Letter
  • Open Access

CD4+ T-lymphocyte alterations in trauma patients

  • 1, 2,
  • 2, 3,
  • 1, 2 and
  • 2, 3Email author
Critical Care201216:432

  • Published:


  • Septic Shock
  • Trauma Patient
  • Lymphocyte Count
  • Injury Severity Score
  • Unfavourable Outcome

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


Overall population (n= 65)

Septic (n= 21)

Nonseptic (n= 44)

Healthy volunteers (n= 50)

CD4+ lymphocytes (cells/μl)

463 ± 274

377 ± 157

500 ± 319

881 ± 261

Regulatory T cells (% of CD4+ lymphocytes)

9.1 ± 2.5

9.6 ± 2.9

8.9 ± 2.3

6.5 ± 1.5

mHLA-DR (antibodies/cell)

8,897 ± 5,762

6,834 ± 4,268

9,927 ± 6,169


Data expressed as the mean ± standard deviation. a Normal values from [4].

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.



monocytic Human Leukocyte Antigen DR.


Authors’ Affiliations

Hospices Civils de Lyon, Hôpital Edouard Herriot, Service de réanimation, Place d'Arsonval, Lyon, 69437, France
Hospices Civils de Lyon/Université Lyon I, EAM 4174, Lyon, 69008, France
Hospices Civils de Lyon, Laboratoire d'Immunologie, Hôpital Edouard Herriot, Place d'Arsonval, Lyon, 69437, France


  1. Heffernan DS, Monaghan SF, Thakkar RK, Machan JT, Cioffi WG, Ayala A: Failure to normalize lymphopenia following trauma is associated with increased mortality, independent of the leukocytosis pattern. Crit Care 2012, 16: R12. 10.1186/cc11157PubMed CentralView ArticlePubMedGoogle Scholar
  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. Crit Care 2010, 14: R208. 10.1186/cc9331PubMed CentralView ArticlePubMedGoogle Scholar
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  4. Docke WD, Hoflich C, Davis KA, Rottgers K, Meisel C, Kiefer P, Weber SU, Hedwig-Geissing M, Kreuzfelder E, Tschentscher P, Nebe T, Engel A, Monneret G, Spittler A, Schmolke K, Reinke P, Volk HD, Kunz D: Monitoring temporary immunodepression by flow cytometric measurement of monocytic HLADR expression: a multicenter standardized study. Clin Chem 2005, 51: 2341-2347. 10.1373/clinchem.2005.052639View ArticlePubMedGoogle Scholar


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