title: Decreased HLA (human leucocyte antigen)-DR expression on peripheral blood monocytes predicts the development of organ failure in patients with acute pancreatitis.
abstract: Immune suppression plays an important role in the pathogenesis of acute pancreatitis. Monocyte expression of HLA (human leucocyte antigen)-DR, a cellular marker of immune suppression, was determined in relation to the development of organ dysfunction in patients with acute pancreatitis. A total of 310 consecutive patients with acute pancreatitis, admitted to a university hospital within 72 h of pain onset, were studied; 194 (63%) had mild disease (group I), 87 (28%) had severe disease without organ dysfunction (group II), and 29 (9%) had severe disease with organ dysfunction (group III). HLA-DR expression, defined both as the proportion of monocytes that were HLA-DR-positive and as monocyte HLA-DR fluorescence intensity, was determined at admission, using whole-blood flow cytometry. Of the patients in group III, 13 (45%) developed organ dysfunction within 24 h of admission. The proportion of HLA-DR-positive monocytes and monocyte HLA-DR density were both related to the severity of pancreatitis (P<0.001 for linear trend). In predicting organ dysfunction, the sensitivity, specificity and positive-likelihood ratio for the proportion of HLA-DR-positive monocytes were 83% [95% CI (confidence interval) 64-94%], 72% (67-77%) and 3.0 respectively, and for monocyte HLA-DR density the respective values were 69% (49-85%), 84% (79-88%) and 4.3. In conclusion, monocyte HLA-DR expression predicts the development of organ dysfunction that occurs early in patients with acute pancreatitis.
authors.affiliation: Department of Bacteriology and Immunology, Haartman Institute, University of Helsinki, Helsinki, Finland. panu.mentula@saunalahti.fi
authors.forename: Panu
authors.initials: P
authors.lastname: Mentula
authors.forename: Marja-Leena
authors.initials: ML
authors.lastname: Kylänpää-Bäck
authors.forename: Esko
authors.initials: E
authors.lastname: Kemppainen
authors.forename: Annika
authors.initials: A
authors.lastname: Takala
authors.forename: Sten-Erik
authors.initials: SE
authors.lastname: Jansson
authors.forename: Hannu
authors.initials: H
authors.lastname: Kautiainen
authors.forename: Pauli
authors.initials: P
authors.lastname: Puolakkainen
authors.forename: Reijo
authors.initials: R
authors.lastname: Haapiainen
authors.forename: Heikki
authors.initials: H
authors.lastname: Repo
mesh_terms: D018806:APACHE; D000208:Acute Disease; D015415:Biomarkers / Q000032:analysis; D002097:C-Reactive Protein / Q000032:analysis; D005434:Flow Cytometry; D006684:HLA-DR Antigens / Q000032:analysis*; D006801:Humans; D009000:Monocytes / Q000276:immunology*; D009102:Multiple Organ Failure / Q000097:blood / Q000276:immunology* / Q000401:mortality; D010195:Pancreatitis / Q000097:blood / Q000276:immunology* / Q000401:mortality; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D012680:Sensitivity and Specificity
chemical_list: D015415:Biomarkers; D006684:HLA-DR Antigens; D002097:C-Reactive Protein