Jun 12: Role of neutrophil biomarkers in immune-based decision making after trauma
Guiding immune-related decisions by objectively determining the patient's immune status, or "immune-based decision making," can be a first step towards personalized treatment after polytrauma. This is what Lilian Hesselink concluded in her thesis for which she obtained her PhD on 12 June.
Physical injury from trauma is the leading cause of death in people under the age of 40 worldwide. Trauma care has improved significantly in recent years. As a result, more and more patients survive an accident. Even the most seriously injured patients (the so-called polytrauma patients) often survive the first days after trauma. However, a significant proportion of these polytrauma patients develop a serious infection in the following week. Such an infection can lead to organ system failure, sometimes leading to death. The root cause in these cases is often a derailment of the immune system.
Neutrophil biomarker
The thesis of Lilian Hesselink (Department of Trauma Surgery, UMC Utrecht) describes several neutrophil biomarkers that can be used for immunomonitoring after trauma. Immunomonitoring can be used to estimate whether and when patients are at risk of serious infectious complications. This is important because in these “at-risk patients” it is desirable to prevent additional tissue damage to minimize the risk of serious infections. In these patients, a choice should be made for “damage control surgery”, which means that only the urgently needed operations are performed immediately and that definitive operations are postponed. These definitive operations are often performed after a few days, when the patient is no longer in acute danger. However, it would be better to let the timing of these procedures depend on the immune status of the patient, since the ultimate goal is to prevent infectious complications.
Immunomonitoring
Immunomonitoring using neutrophil biomarkers would provide a solution to closely monitor the immune status of a polytrauma patient. Other immune-related decisions after trauma would include the administration of preventive antibiotics and appropriate nutrition to reduce the risk of infections. The choice and timing of these measures is currently determined by the surgeon's estimation, often in combination with logistical reasons. The surgeon's estimate remains a rough estimate of the patient's immune status. After all, each polytrauma patient reacts differently to injury. This immune response can be measured by analyzing neutrophil biomarkers, or immunomonitoring. Making immune-related decisions guided by the immune status of the patient, or “immune-based decision making”, would therefore be a first step towards personalized treatment after polytrauma.
PhD defense
Lillian Hesselink (1991, Hamburg, Germany) defended her PhD thesis on June 12, 2020 at Utrecht University. The title of his thesis was “Neutrophil biomarkers after trauma - A first step towards immune-based decision making”. Supervisors were prof. dr. Loek Leenen (Department of Trauma Surgery, UMC Utrecht) and prof. dr. Leo Koenderman (Department of Experimental Pulmonary Diseases, UMC Utrecht). Co-supervisor was dr. Falko Hietbrink (Department of Trauma Surgery, UMC Utrecht). Currently, Lillian works as a resident (not in training) at the department of Intensive Care of Ziekenhuis Gelderse Vallei in Ede.