Expansion of CD14+CD16+ monocytes in critically ill cardiac surgery patients.
We have asked whether critically ill cardiac valve surgery patients identified by a high APACHE II score exhibit an increase in the number of proinflammatory CD14+CD16+ monocytes. A group of 12 patients was studied over a period of 5 days post cardiac valve surgery for changes in blood monocyte populations. Patients were selected on day 1 post surgery to either be in good clinical condition (APACHE II Score of < or = 14; N = 9) or to be critically ill (APACHE II score of > or = 24; N = 3). The < or = 14 patients had an uneventful course and could leave the ICU after 2-3 days. Among the > or = 24 patients two showed a decrease of the score to < or = 14 within the 5 days of observation and they could leave the ICU thereafter. One > or = 24 patient (patient #2) had a persistently high score and finally died on day 28. Analysis of blood monocytes on day 1 post surgery revealed that the < or = 14 patients had normal values of CD14+CD16+ monocytes (44 +/- 9/microliter). By contrast the > or = 24 patients had increased values of these cells with 243 +/- 106 cells per microliter on day 1. The numbers of CD14+CD16+ monocytes returned to the control range over the 5 days of observation in 2 of the > or = 24 patients concomitant with the improvement of the APACHE II score. CD14+CD16+ monocytes remained, however, at a high level in patient #2, the patient with persistently high APACHE II score.
Department of Internal Medicine I, Klinikum Grosshadern, University of Muenchen, FRG.
G
G
Fingerle-Rowson
J
J
Auers
E
E
Kreuzer
P
P
Fraunberger
M
M
Blumenstein
L H
LH
Ziegler-Heitbrock
D018806:APACHE; D000368:Aged; D016022:Case-Control Studies; D016638:Critical Illness; D005260:Female; D006684:HLA-DR Antigens / Q000097:blood; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects*; D006801:Humans; D007249:Inflammation / Q000097:blood* / Q000209:etiology*; D015850:Interleukin-6 / Q000097:blood; D007958:Leukocyte Count; D018950:Lipopolysaccharide Receptors / Q000097:blood; D016173:Macrophage Colony-Stimulating Factor / Q000097:blood; D008297:Male; D008875:Middle Aged; D009000:Monocytes / Q000276:immunology* / Q000473:pathology; D011183:Postoperative Complications / Q000097:blood* / Q000209:etiology*; D011446:Prospective Studies; D017452:Receptors, IgG / Q000097:blood; D018805:Sepsis / Q000097:blood / Q000209:etiology; D014409:Tumor Necrosis Factor-alpha / Q000378:metabolism
D006684:HLA-DR Antigens; D015850:Interleukin-6; D018950:Lipopolysaccharide Receptors; D017452:Receptors, IgG; D014409:Tumor Necrosis Factor-alpha; D016173:Macrophage Colony-Stimulating Factor