title: Predictive value of monocyte histocompatibility leukocyte antigen-DR expression and plasma interleukin-4 and -10 levels in critically ill patients with sepsis.
abstract: It has been suggested that excessive activation of the anti-inflammatory pathways in sepsis may lead to poor outcome of patients with sepsis. The aim of this study was to test the value of histocompatibility leukocyte antigen (HLA)-DR-expression on blood monocytes and plasma levels of interleukin (IL)-4 and -10 in prediction of hospital mortality in patients with sepsis. Sixty-one critically ill patients with sepsis were prospectively enrolled to this study in two university hospital intensive care units. Survivors (n = 41) and nonsurvivors (n = 20) differed significantly in HLA-DR expression at admission: survivors' median 84% (interquartile range 64%-98%) versus nonsurvivors' median 62% (interquartile range 47%-83%, P = 0.025 by Mann-Whitney test). Similarly, the analysis revealed statistically significant differences between survivors and nonsurvivors in admission plasma IL-10 levels and in admission Sequential Organ Failure Assessment (SOFA) and Acute Physiology and Chronic Health Evaluation (APACHE) II scores, but not in IL-4 levels. The areas under receiver operating curves (AUC) showed that both monocyte HLA-DR expression and plasma IL-4 level showed poor discriminative power in prediction of hospital mortality (AUC < 0.70). Only IL-10 levels on days 1 and 2 showed reasonable predictive power (AUCs 0.706 and 0.725, respectively). The highest AUC values were those of APACHE-II (0.786) and admission SOFA score (0.763). In conclusion, APACHE II and SOFA scores on admission showed better discriminatory power than HLA-DR expression and IL-10 and IL-4 levels in prediction of hospital mortality in critically ill patients with sepsis.
authors.affiliation: Department of Anesthesia and Intensive Care Medicine, Helsinki University Central Hospital, PO Box 340, 00029 HUS, Helsinki, Finland. marja.hynninen@hus.fi
authors.forename: Marja
authors.initials: M
authors.lastname: Hynninen
authors.forename: Ville
authors.initials: V
authors.lastname: Pettilä
authors.forename: Olli
authors.initials: O
authors.lastname: Takkunen
authors.forename: Riitta
authors.initials: R
authors.lastname: Orko
authors.forename: Sten-Erik
authors.initials: SE
authors.lastname: Jansson
authors.forename: Pentti
authors.initials: P
authors.lastname: Kuusela
authors.forename: Risto
authors.initials: R
authors.lastname: Renkonen
authors.forename: Matti
authors.initials: M
authors.lastname: Valtonen
mesh_terms: D018806:APACHE; D000328:Adult; D019540:Area Under Curve; D016638:Critical Illness; D005260:Female; D006684:HLA-DR Antigens / Q000378:metabolism*; D006801:Humans; D016753:Interleukin-10 / Q000097:blood*; D015847:Interleukin-4 / Q000097:blood*; D008297:Male; D008875:Middle Aged; D009000:Monocytes / Q000378:metabolism*; D011237:Predictive Value of Tests; D018805:Sepsis / Q000097:blood* / Q000401:mortality*; D012772:Shock, Septic / Q000097:blood / Q000401:mortality; D015996:Survival Rate
chemical_list: D006684:HLA-DR Antigens; D016753:Interleukin-10; D015847:Interleukin-4