This observation is consistent with recent findings reported by Lukaszewicz and colleagues [59] in surgical patients. Significantly, in the present study, multivariate logistic regression analysis indicated that low mHLA-DR expression was independently associated with the development of sepsis, whereas all the other parameters included www.selleckchem.com/products/mek162.html in the analysis (ISS, SAPS II, presence of a severe brain trauma, and massive transfusion) were not predictive. A slope of mHLA-DR of less than 1.2 was independently associated with the risk of developing sepsis, a finding that reflects the possible pivotal role of immune dysfunction in the increased risk of infection in trauma patients.

In Table Table11 some variables that may seem relevant (like the length of stay in the ICU and the duration of mechanical ventilation) were not included in the multivariate analysis, because they have to be considered as a consequence of the development of sepsis and not a risk factor. Moreover, it has to be considered that the onset of sepsis is early (median at day 4) and that every patient was still in the ICU at this time point.Chest trauma is reported to account for one third of acute-trauma emergency room admissions, and 30% to 75% of trauma patients have pulmonary contusions [60], usually as a result of rapid deceleration [61]. The incidence of lung injury seemed to be quite significant in our study (72%) and is probably due to the severity of the trauma patients included. However, there were no differences between the presences of thoracic injury between infected and non-infected groups.

The pathophysiology of pulmonary contusion includes a strong inflammatory response in the lung parenchyma, resulting in increased alveolocapillary permeability, pulmonary edema, ventilation/perfusion mismatch, increased pulmonary shunting, and loss of compliance. As at the systemic level, this local response is followed by an anti-inflammatory response. Muehlstedt and colleagues [19] observed not only altered HLA-DR expression on the surface of alveolar macrophages in the lungs of trauma patients who developed sepsis but also altered production of other cytokines. Local organ immunosuppression was present and Carfilzomib may have been responsible for the development of nosocomial pneumonia in the injured patients [19].As far as the authors can ascertain, this is the first study, using the standardized test described by the European multicenter study [33] and multivariate analysis, aimed specifically at evaluating mHLA-DR expression in a cohort of severe trauma patients. Most previous studies have been conducted in smaller series of patients spanning a highly variable spectrum of severity (from mild to severe trauma) [15-17,58].