The systemic immune response to trauma: an overview of pathophysiology and treatment

Janet M Lord, Mark J Midwinter, Yen-Fu Chen, Antonio Belli, Karim Brohi, Elizabeth J Kovacs, Leo Koenderman, Paul Kubes, Richard J Lilford

Research output: Contribution to journalReview articlepeer-review

254 Citations (Scopus)


Improvements in the control of haemorrhage after trauma have resulted in the survival of many people who would otherwise have died from the initial loss of blood. However, the danger is not over once bleeding has been arrested and blood pressure restored. Two-thirds of patients who die following major trauma now do so as a result of causes other than exsanguination. Trauma evokes a systemic reaction that includes an acute, non-specific, immune response associated, paradoxically, with reduced resistance to infection. The result is damage to multiple organs caused by the initial cascade of inflammation aggravated by subsequent sepsis to which the body has become susceptible. This Series examines the biological mechanisms and clinical implications of the cascade of events caused by large-scale trauma that leads to multiorgan failure and death, despite the stemming of blood loss. Furthermore, the stark and robust epidemiological finding--namely, that age has a profound influence on the chances of surviving trauma irrespective of the nature and severity of the injury--will be explored. Advances in our understanding of the inflammatory response to trauma, the impact of ageing on this response, and how this information has led to new and emerging treatments aimed at combating immune dysregulation and reduced immunity after injury will also be discussed.

Original languageEnglish
Article number9952
Pages (from-to)1455-1465
Number of pages11
JournalThe Lancet
Issue number9952
Publication statusPublished - 18 Oct 2014


  • Age Factors
  • Endocrine System
  • Hemostasis
  • Humans
  • Immunity, Innate
  • Neutrophils
  • Sex Factors
  • Systemic Inflammatory Response Syndrome
  • Wounds and Injuries


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