Key result
Elevated perioperative neutrophil and monocyte L-selectin were significant predictors of postoperative sepsis (AUC 0.692 and AUC 0.761, respectively), comparable to C-reactive protein.
Why the study?
Deciding whether to delay non-lifesaving orthopaedic trauma surgery to prevent multiple organ failure or sepsis is frequently disputed and largely based on expert opinion.
Do neutrophil and monocyte L-selectin predict postoperative sepsis and multiple organ failure in orthopaedic trauma patients?
Observational (n=182)
Do neutrophil and monocyte L-selectin predict postoperative sepsis and multiple organ failure in orthopaedic trauma patients?
Elevated perioperative neutrophil and monocyte L-selectin are predictive of postoperative sepsis and multiple organ failure in orthopaedic trauma patients, performing similarly to CRP.
May support L-selectin for sepsis risk stratification in trauma; hypothesis-generating and requires prospective validation.
Deciding whether to delay non-lifesaving orthopaedic trauma surgery to prevent multiple organ failure (MOF) or sepsis is frequently disputed and largely based on expert opinion. We hypothesise that neutrophils and monocytes differentially express activation markers prior to patients developing these complications. Peripheral blood from 20 healthy controls and 162 patients requiring major orthopaedic intervention was collected perioperatively. Neutrophil and monocyte L-selectin, CD64, CD11, CD18, and CXCR1 expression were measured using flow cytometry. The predictive ability for MOF and sepsis was assessed using the Receiver Operating Characteristic (ROC) comparing to C-reactive protein (CRP). Neutrophil and monocyte L-selectin were significantly higher in patients who developed sepsis. Neutrophil L-selectin (AUC 0.692 [95%CI 0.574-0.810]) and monocyte L-selectin (AUC 0.761 [95%CI 0.632-0.891]) were significant predictors of sepsis and were not significantly different to CRP (AUC 0.772 [95%CI 0.650-0.853]). Monocyte L-selectin was predictive of MOF preoperatively and postoperatively (preop AUC 0.790 [95%CI 0.622-0.958]). CD64 and CRP were predictive of MOF at one-day postop (AUC 0.808 [95%CI 0.643-0.974] and AUC 0.809 [95%CI 0.662-0.956], respectively). In the perioperative period, elevated neutrophil and monocyte L-selectin are predictors of postoperative sepsis. Larger validation studies should focus on these biomarkers for deciding the timing of long bone/pelvic fracture fixation.
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Briggs et al. (2021) conducted an observational in Orthopaedic trauma (n=182). Elevated neutrophil and monocyte L-selectin vs. C-reactive protein (CRP) was evaluated on Postoperative sepsis (AUC 0.761, 95% CI 0.632-0.891). Elevated perioperative neutrophil and monocyte L-selectin were significant predictors of postoperative sepsis (AUC 0.692 and AUC 0.761, respectively), comparable to C-reactive protein.
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