Persisting low monocyte human leukocyte antigen-DR expression predicts mortality in septic shock.
OBJECTIVE
The immediate overwhelming release of inflammatory mediators in septic shock is rapidly followed by strong anti-inflammatory responses inducing a state of immunosuppression. The patients who survive the initial hyper-inflammatory step of septic shock but subsequently die may be those who do not recover from immunosuppression. We assessed whether a low monocyte human leukocyte antigen-DR (mHLA-DR) expression, proposed as a marker of immunosuppression, is an independent predictor of mortality in patients who survived the initial 48 h of septic shock.


METHODS
Prospective observational study performed in two adult intensive care units at a university hospital.


METHODS
93 consecutive patients with septic shock.


RESULTS
At days 1-2, mHLA-DR values (determined by flow cytometry) were not significantly different between survivors and non-survivors. A sharp difference became highly significant at days 3-4 when survivors had increased their values, while non-survivors had not (43% vs. 18%, percentage of HLA-DR positive monocyte, p < 0.001). Multivariate logistic regression analysis revealed that low mHLA-DR (< 30%) at days 3-4 remained independently associated with mortality after adjustment for usual clinical confounders, adjusted odds ratio (CI): 6.48 (95% CI: 1.62-25.93).


CONCLUSIONS
The present preliminary results show that mHLA-DR is an independent predictor of mortality in septic shock patients. Being a marker of immune failure, low mHLA-DR may provide a rationale for initiating therapy to reverse immunosuppression. After validation of the current results in multicenter studies, mHLA-DR may help to stratify patients when designing a mediator-directed therapy in a time-dependent manner.
Monneret
Guillaume
G
Immunology Laboratory, Hôpital Neurologique, Lyon, France. guillaume.monneret@chu-lyon.fr
Lepape
Alain
A
Voirin
Nicolas
N
Bohé
Julien
J
Venet
Fabienne
F
Debard
Anne-Lise
AL
Thizy
Hélène
H
Bienvenu
Jacques
J
Gueyffier
François
F
Vanhems
Philippe
P
D000368:Aged; D005260:Female; D006684:HLA-DR Antigens / Q000096:biosynthesis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009000:Monocytes / Q000276:immunology*; D011379:Prognosis; D011446:Prospective Studies; D012772:Shock, Septic / Q000276:immunology* / Q000401:mortality*; D015996:Survival Rate
D006684:HLA-DR Antigens