title: Is low monocyte HLA-DR expression helpful to predict outcome in severe sepsis?
abstract: OBJECTIVE
  Low monocyte human leukocyte antigen-DR (HLA-DR) expression has been reported to be an indicator of poor survival in critically ill septic patients. We assessed its usefulness as a prognostic indicator in order to identify possible interventions to normalise HLA-DR expression in those patients with lowered monocyte HLA-DR.
  
  
  METHODS
  HLA-DR expression was measured on separated monocytes of septic patients, using flow cytometry, and HLA-DR upregulation was measured by the same techniques after ex vivo stimulation with granulocyte macrophage colony stimulating factor (GM-CSF). APACHE II score, age, sex and outcome were determined for all patients.
  
  
  METHODS
  A single-centre study at the Royal Liverpool University Hospital in a medico-surgical 13-bed intensive care unit.
  
  
  METHODS
  All septic patients ( n=70) fulfilling the criteria of the ACCP for the diagnosis of sepsis were recruited for the study with informed consent from day 1 of diagnosis of sepsis and monocyte HLA-DR expression measured on 3 consecutive days. Patients were excluded from the study if they were on immunosuppressive therapy. Normal healthy volunteers ( n=45) were included.
  
  
  RESULTS
  Low monocyte surface expression and median fluorescence density HLA-DR expression was not associated with a high mortality. High APACHE II scores were not correlated with low HLA-DR expression. However, in those patients where HLA-DR expression was lowered, this could be restored ex vivo by GM-CSF.
  
  
  CONCLUSIONS
  In the group of septic patients under study, HLA-DR was not a useful prognostic marker of outcome. We did not find a higher mortality in the group of patients who had low expression. These findings are contradictory to some previously reported findings, and the possible reasons are discussed.
authors.affiliation: Departments of Immunology and Clinical Chemistry, Duncan Building, University of Liverpool, Daulby Street, L69 3GA, Liverpool, UK.
authors.forename: Sara E
authors.initials: SE
authors.lastname: Perry
authors.forename: Sobhy M
authors.initials: SM
authors.lastname: Mostafa
authors.forename: Richard
authors.initials: R
authors.lastname: Wenstone
authors.forename: Alan
authors.initials: A
authors.lastname: Shenkin
authors.forename: Paul J
authors.initials: PJ
authors.lastname: McLaughlin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers; D016022:Case-Control Studies; D005260:Female; D005434:Flow Cytometry; D016178:Granulocyte-Macrophage Colony-Stimulating Factor / Q000627:therapeutic use; D006684:HLA-DR Antigens / Q000097:blood*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009000:Monocytes / Q000276:immunology*; D011379:Prognosis; D018805:Sepsis / Q000175:diagnosis* / Q000188:drug therapy / Q000276:immunology / Q000401:mortality
chemical_list: D015415:Biomarkers; D006684:HLA-DR Antigens; D016178:Granulocyte-Macrophage Colony-Stimulating Factor