title: HLA-DR expression on monocytes and systemic inflammation in patients with ruptured abdominal aortic aneurysms.
abstract: BACKGROUND
  Mortality from ruptured abdominal aortic aneurysms (RAAA) remains high. Severe systemic inflammation, leading to multi-organ failure, often occurs in these patients. In this study we describe the level of HLA-DR expression in a consecutive group of patients following surgery for RAAA and compare results between survivors and non-survivors. A similar comparison is made for IL-6, IL-10 levels and SOFA-scores.
  
  
  METHODS
  This is a prospective observational study. Patients with RAAA were prospectively analyzed. Blood samples were collected on day 1, 3, 5, 7, 10 and 14. The fraction of CD-14 positive monocytes expressing HLA-DR was measured by flow-cytometry. Interleukin-6 and interleukin-10 levels were measured by ELISA.
  
  
  RESULTS
  Thirty patients with a median age of 70 years were included. There were 27 (90%) men. Six patients died from multiple organ failure, all other patients survived. The Sequential Organ Failure Assessment (SOFA) scores were significantly higher in non-survivors on day 1 through 14. HLA-DR expression on monocytes was significantly lower on day 3, 5, 7, 10 and 14 in non-survivors. Interleukin-6 and IL-10 levels were significantly higher in non-survivors on day 1 and day 1 and 3 respectively.
  
  
  CONCLUSIONS
  HLA-DR expression on monocytes was decreased, especially in non-survivors. All patients with RAAA displayed a severe inflammatory and anti-inflammatory response with an increased production of IL-6 and IL-10. Poor outcome is associated with high levels of IL-6 and IL-10 and a high SOFA score in the first three days after surgery, while low levels of HLA-DR expression are observed from day three after RAAA repair.
authors.affiliation: Department of Surgery, Surgical Intensive Care Unit, University Medical Center Groningen, University of Groningen Hanzeplein 1, P.O. Box: 30.001 9700 RB Groningen, The Netherlands. janwillemhaveman@gmail.com
authors.forename: Jan Willem W
authors.initials: JW
authors.lastname: Haveman
authors.forename: Aad P
authors.initials: AP
authors.lastname: van den Berg
authors.forename: Eric L G
authors.initials: EL
authors.lastname: Verhoeven
authors.forename: Maarten W N
authors.initials: MW
authors.lastname: Nijsten
authors.forename: Jan J A M
authors.initials: JJ
authors.lastname: van den Dungen
authors.forename: Hauw T
authors.initials: HT
authors.lastname: The
authors.forename: Jan H
authors.initials: JH
authors.lastname: Zwaveling
mesh_terms: D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000276:immunology / Q000378:metabolism*; D001019:Aortic Rupture / Q000276:immunology / Q000378:metabolism*; D005260:Female; D005786:Gene Expression Regulation / Q000502:physiology; D006684:HLA-DR Antigens / Q000096:biosynthesis* / Q000276:immunology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009000:Monocytes / Q000276:immunology / Q000378:metabolism*; D011446:Prospective Studies; D018746:Systemic Inflammatory Response Syndrome / Q000276:immunology / Q000378:metabolism*
chemical_list: D006684:HLA-DR Antigens