Very low monocytic HLA-DR expression indicates high risk of infection--immunomonitoring for patients after neurosurgery and patients during high dose steroid therapy.
In patients with disturbed immunoreactivity caused by trauma or immunosuppressive therapy infections are still a severe problem. To determine whether measurement of monocytic HLA-DR expression is useful for identifying patients with a high risk of infection after elective neurosurgery, blood was obtained from 57 patients during the first 3 days after surgery. HLA-DR expression was lower in 14 patients who developed infection, compared with patients with an uncomplicated postoperative course (p < 0.0001). Out of ten patients with less than 30% HLA-DR positive monocytes, nine developed infection. In 11 neurosurgical patients additional investigations were performed. Measurements in these patients show that HLA-DR expression decreased temporarily within hours after surgery, coinciding with a considerable increase of inflammatory cytokines in CSF, but, surprisingly, not in plasma. High plasma concentrations of ACTH and cortisol hours after surgery indicated a hypothalamus-pituitary axis response, probably involved in the downregulation of monocytic HLA-DR expression. Likewise, monitoring of dermatological patients (n = 10) who received high dose systemic steroids revealed a very low HLA-DR expression in those patients who later developed infection. Our studies show that very low HLA-DR expression indicates high risk of infection. We recommend the measurement of this parameter for immunomonitoring.
Asadullah
K
K
Department of Dermatology, University Hospital Charité, Berlin Humboldt University, Germany.
Woiciechowsky
C
C
Döcke
W D
WD
Egerer
K
K
Kox
W J
WJ
Vogel
S
S
Sterry
W
W
Volk
H D
HD
D000328:Adult; D000368:Aged; D001424:Bacterial Infections / Q000175:diagnosis* / Q000209:etiology; D015415:Biomarkers / Q000032:analysis; D002555:Cerebrospinal Fluid / Q000276:immunology; D016009:Chi-Square Distribution; D003399:Craniotomy / Q000009:adverse effects*; D004305:Dose-Response Relationship, Drug; D005260:Female; D005434:Flow Cytometry; D006684:HLA-DR Antigens / Q000032:analysis*; D006801:Humans; D016867:Immunocompromised Host / Q000276:immunology; D007165:Immunosuppression Therapy; D007166:Immunosuppressive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D009000:Monocytes / Q000276:immunology*; D011239:Prednisolone / Q000009:adverse effects* / Q000627:therapeutic use; D012680:Sensitivity and Specificity; D012871:Skin Diseases / Q000188:drug therapy / Q000276:immunology
D015415:Biomarkers; D006684:HLA-DR Antigens; D007166:Immunosuppressive Agents; D011239:Prednisolone