Superoxide production of neutrophils after severe injury: Impact of subsequent surgery and sepsis

To evaluate the early variations of superoxide production of neutrophils (SPN) in injured patients, SPN was serially measured on the first, third, and seventh day after severe injury (injury severity score of>16). For patients receiving subsequent surgery, SPN was measured again on the first postoperative day. Eighteen patients were studied. Six had subsequent surgery within 1 day (early operation); 6 had surgery 3 days after injury (late operation); 6 did not have surgery (nonoperation). SPN increased on the first day and recovered from the third day after injury in all three groups. In patients who had surgery, SPN did not significantly increase on the first postoperative day. Eight patients developed sepsis, 4 of whom had early multiple organ dysfunction (EMOD). On the last measurement, mean SPN was suppressed in septic patients with EMOD, whereas it was elevated in septic patients without EMOD. Patients with EMOD also had a higher injury severity score. In conclusion, subsequent surgery after injury has no effect on the priming of neutrophils. While late priming of neutrophils in injured patients coincides with the development of sepsis, suppression of SPN is found in septic patients with EMOD that frequently results from severe injury.