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Early measurement of double negative (CD4-CD8) T-cells as a possible predictor for MODS after severe blunt trauma?

The exact pathogenesis of the multiple organ dysfunction syndrome (MODS) as the leading cause of late postinjury death is still unclear. We investigated 35 patients with an injury severity score (ISS) greater than 15 (range: 17 to 50, mean 30) and an age greater than 16) years (range: 16 to 89; mean: 38.1 years) during the first 6 days after severe blunt trauma. Patients who died within the first 24 h were excluded. The clinical state of the patients was - among various other clinical parameters and scores - examined by daily calculating of the multiple organ failure score according to Goris et al. To recognize immunological alterations in the early postinjury phase, we observed several subpopulations of lymphocytes (labelled with monoclonal antibodies and analysed by flow cytometry) at 10 times, starting at the site of accident.

Two of the regarded cell-groups were T-lymphocytes (CD3+) and one of their subpopulations, the double negative T-cells (CD3+ CD4-CD8-). The vast majority of these cells are ?d-T-cells [1], a little cell population (1 to 9% of the T-cells) which expresses another T-cell receptor as the longer known aß-T-cells. To ascertain that the examined cells were really ?d-T-cells, we additionally labelled the cells of the last seven patients with ?d-antibodies, compared both groups and noticed that they were corresponding.

?d-T-cells are completely different from aß-T-cells, eg they do not show MHC-restriction. Although their exact function remains still (10 years after discovery) unknown, they have some characteristics which seem to be very interesting for our examination [2,3]: (i) Their prominent residence epithelial tissues, primary in the intestines, an area which is strongly involved into the early pathogenesis of MODS. (ii) They show a rapid mobilisation in the early response to infections. (iii) They have immunoregulating functions for the specific and non-specific immune system and they secrete many lymphokines.

Corresponding with these functional descriptions, we found significant differences (Wilcoxon two sample test for groups of cases: P < 0.0001) in the counts of double negative T-cells during the first two samples (site of accident and emergency room) (Fig). The patients with severe MODS (reaching a Goris-score of = 5 during the observation period) showed high cell counts whereas the other patients showed low cell counts (moderate: P25 = 38/µl, P50 = 56/µl, P75, = 72/µ severe: P25 = 159/µl. P50 = 181/µl. P75 = 272/µl). To exclude the possibility that this effect would not be limited on ?d-T-cells, but would be characteristic for all T-cells or for all lymphocytes, we examined the ratio of ?d-T-cells to all T-cells and we saw a less clear, but significant and similar picture (moderate: P25 = 3.2%. P50 = 5.4%, P75 = 7.25%; severe: P25 = 7.75%, P50 = 9.55%, P75= 14%). We further controlled the influence of other clinical parameters on the MODS (by using Fisher's Exact Test), but we found no statistical connection between any other clinical parameter and the multiple organ dysfunction.

Thus the MODS seems to be related with the number of ?d-T-lymphocytes in the first hour after severe blunt trauma.

figure 1

Numbers of double negative T-cells during the first 144 h after severe blunt trauma. Patients, who get a severe MODS (Goris-score = 5) during the first 6 days after injury, have initial (site of accident/emergency room) significant higher cell numbers as the other patients (P < 0.0001). Ten timepoints are summarized to four groups due to statistical reasons.


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Ahlers, O., Keh, D., Gerlach, M. et al. Early measurement of double negative (CD4-CD8) T-cells as a possible predictor for MODS after severe blunt trauma?. Crit Care 1 (Suppl 1), P012 (1997).

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