Objective: To investigate associations between impaired blood polymorphonuclear leukocyte (PMN) migration and infections in traumatized patients.

Patients: Fifteen patients after hip joint surgery with uneventful recovery; 26 ICU patients with multiple trauma, nine of whom contracted hospital infections; 11 ICU patients after cardiogenic shock, all of whom contracted hospital infections.

Methods:  PMN migration was measured daily in whole blood with a membrane filter method until the patients’ discharge from the respective departments. The relevant parameter was the percentage of PMNs migrating from the blood into the filters upon F-Met-Leu-Phe stimulation. The reaction profiles of the three groups of patients were compared. In the cardiogenic shock patients, the phorbol mystirate acetate - stimulated reactive oxygen species (ROS) release by phagocytes was also measured in whole blood with luminal-enhanced chemiluminescence.

Results: The values of the first posttraumatic day were taken as a reference baseline.

Non-infected patients: In surgical trauma, migration decreased transiently to 62% of baseline value on days three and four and returned to baseline further on. Equally, the group of non-infected multiple trauma patients generally remained at baseline level throughout the observation period. Infected patients: In multiple trauma, migration fell to 31% of baseline on days three, four and five and continued depressed, with intermittent returns to baseline. PMN migration below a critical minimum preceded infections and showed marker quality to predict infections with a sensitivity of 88% and a specificity of 82%. Cardiogenic shock developed a profile similar to infections in multiple trauma with a maximum decrease to 42% of baseline on days three and five. ROS release correlated negatively with migration. PMNs in infected patients tended to form aggregates during migration in the membrane filters. Migration and ROS release did not correlate with injury severity (ISS) and APACHE III scores.

Conclusions: Impaired oriented PMN migration in traumatized patients signals and correlates with proneness to infections. Low PMN migratory capacity was found to be associated with a high readiness to form aggregates and to release ROS. This constellation suggests that the defective host defense favouring infections may be partially based on a PMN dysfunction that may be characterized as “hyperpriming”