Base deficit after major trauma directly relates to neutrophil CD11b expression: a proposed mechanism of shock-induced organ injury.

OBJECTIVE

To determine whether expression of neutrophil integrin receptors is related to the degree of post-traumatic shock.

DESIGN

Data were collected prospectively on patients with major trauma admitted to the surgical intensive care unit.

SETTING

Denver General Hospital, Colorado.

PATIENTS AND

PARTICIPANTS

17 severely injured adults.

MEASUREMENTS AND

RESULTS

The mean fluorescence intensity and per cent positive of neutrophil integrin receptors CD11 b, CD18 and CD11 a, and systolic blood pressure, blood transfusion, lactate and base deficit as indices of shock. CD11 b expression on circulating neutrophils was increased 6 and 12 h after trauma. After correcting for the other shock indices, base deficit predicted CD11 b expression at 12 h. CD11 b expression was negatively correlated with the circulating neutrophil count.

CONCLUSIONS

The degree of metabolic acidosis after trauma correlates directly with CD11 b receptor expression on circulating neutrophils. This relation may be the mechanism whereby post-traumatic shock results in neutrophil sequestration and neutrophil-mediated organ injury and failure.