INNATE IMMUNE FUNCTION PREDICTS THE DEVELOPMENT OF NOSOCOMIAL INFECTION IN CRITICALLY INJURED CHILDREN

作者：Muszynski Jennifer A; Nofziger Ryan; Greathouse Kristin; Nateri Jyotsna; Hanson Huber Lisa; Steele Lisa; Nicol Kathleen; Groner Jonathan I; Besner Gail E; Raffel Corey; Geyer Susan; El Assal Osama; Hall Mark W^*

来源：Shock, 2014, 42(4): 313-321.

DOI：10.1097/SHK.0000000000000217

• Trauma
• suppression
• complications
• TNF-alpha
• pediatric
• PICU

Background: Critical injury has been associated with reduction in innate immune function in adults, with infection risk being related to degree of immune suppression. This relationship has not been reported in critically injured children. Hypothesis: Innate immune function will be reduced in critically injured children, and the degree of reduction will predict the subsequent development of nosocomial infection. Methods: Children (<= 18 years old) were enrolled in this longitudinal, prospective, observational, single-center study after admission to the pediatric intensive care unit following critical injury, along with a cohort of outpatient controls. Serial blood sampling was performed to evaluate plasma cytokine levels and innate immune function as measured by ex vivo lipopolysaccharide-induced tumor necrosis factor alpha (TNF-alpha) production capacity. Results: Seventy-six critically injured children (and 21 outpatient controls) were enrolled. Sixteen critically injured subjects developed nosocomial infection. Those subjects had higher plasma interleukin 6 and interleukin 10 levels on posttrauma days 1-2 compared with those who recovered without infection and outpatient controls. Ex vivo lipopolysaccharide-induced TNF-alpha production capacity was lower on posttrauma days 1-2 (P = 0.006) and over the first week following injury (P = 0.04) in those who went on to develop infection. A TNF-alpha response of less than 520 pg/mL at any time in the first week after injury was highly associated with infection risk by univariate and multivariate analysis. Among transfused children, longer red blood cell storage age, not transfusion volume, was associated with lower innate immune P < 0.0001). Trauma-induced innate immune suppression was reversible ex vivo via coculture of whole blood with granulocyte-macrophage colony-stimulating factor. Conclusions: Trauma-induced innate immune suppression is common in critically injured children and is associated with increased risks for the development of nosocomial infection. Potential exacerbating factors, including red blood cell transfusion, and potential therapies for pediatric trauma-induced innate immune suppression are deserving of further study.

• 出版日期2014-10