Looking for the immunological “time window” for the surgical intervention in patients with polytrauma

Background: Polytrauma patients with a severity score over 16 points are at a risk of development 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 polytrauma during a period of time, which is critical for therapeutic decisions. The phagocytic arm is analyzed to optimize the timing of definitive surgery. Material and methods: The study group consisted of 7 men and 5 women from 20 to 84 years of age who had sustained a polytrauma as a result of mechanical factors. Polytrauma was severe (over 16 points ISS – Injury Severity Score) in all of the cases. All patients were studied on the 3rd and 6th day after trauma. Nine CNS-injured patients (isolated injury) and eleven healthy age- and sex-matched volunteers served as controls. Results: A statistically significant and higher individual cellular phagocytic activity (number of bacteria per cell) was observed in polytrauma patients on the 3rd day when compared to CNS-injured patients. The percentages of granulocytes showing phagocytosis in polytrauma patients on the 3rd and 6th day were significantly lower when compared to CNS-injured patients and healthy controls. The percentages of granulocytes showing enzymatic activity in polytrauma patients on the 3rd and 6th day were significantly lower comparing to CNS-injured patients and healthy controls. Statistically significant and higher enzymatic activity of granulocytes was observed on the 3rd and 6th day in polytrauma patients when compared to healthy controls. Conclusions: A significant deficiency of the phagocytic arm was observed during a period of time, which is critical for definitive surgical interventions in polytrauma patients. The phagocytic arm should be analyzed to optimize the timing of definitive surgery.