title: Decreased monocyte human leukocyte antigen-DR expression after severe burn injury: Correlation with severity and secondary septic shock.
abstract: OBJECTIVE
  Severe thermal injury causes immune dysfunctions involving both pro- and anti-inflammatory mechanisms. It subsequently leads to a state of immune deficiency that shares some similarities with sepsis-induced immunosuppression. A hallmark of the latter is established by decreased monocyte human leukocyte antigen-DR (mHLA-DR) measurements. The main objective of the current study was to characterize the appearance and the duration of low mHLA-DR expression after severe burn as well as to determine its correlation with mortality and septic complications.
  
  
  METHODS
  Observational study.
  
  
  METHODS
  Burn unit (intensive care unit) in a university hospital.
  
  
  METHODS
  Severe burn patients (total burn surface area >30%, n = 14) and healthy individuals (n = 29).
  
  
  METHODS
  None.
  
  
  RESULTS
  Patients were immunologically monitored during 15 days. We quantified mHLA-DR expression with a standardized flow cytometry protocol. Every patient presented with decreased mHLA-DR expression at days 2-3 after burn. Then, from days 4-6, this expression increased in patients who would survive whereas it remained low in nonsurvivors. As early as days 7-10 after burn, patients who were going to develop secondary septic shock exhibited significantly lower mHLA-DR expression in comparison with patients recovering without severe septic complications. Using quantitative reverse transcriptase-polymerase chain reaction, at days 4-6, we found that the RNA level of the nonpolymorphic HLA-DRA chain and the transcription factor class II transactivator were also significantly decreased compared with healthy controls; however, plasma cytokines (interleukin-6, tumor necrosis factor-alpha, and interleukin-10) did not provide any significant prognostic information.
  
  
  CONCLUSIONS
  Severe burn injury induced a marked reduction in mHLA-DR expression at both protein and messenger RNA levels. Its persistent decrease was associated with mortality and the development of septic complications.
authors.affiliation: Hospices Civils de Lyon, Hôpital Neurologique, Laboratoire d'Immunologie, Lyon, France.
authors.forename: Fabienne
authors.initials: F
authors.lastname: Venet
authors.forename: Sylvie
authors.initials: S
authors.lastname: Tissot
authors.forename: Anne-Lise
authors.initials: AL
authors.lastname: Debard
authors.forename: Caroline
authors.initials: C
authors.lastname: Faudot
authors.forename: Carine
authors.initials: C
authors.lastname: Crampé
authors.forename: Alexandre
authors.initials: A
authors.lastname: Pachot
authors.forename: Alfred
authors.initials: A
authors.lastname: Ayala
authors.forename: Guillaume
authors.initials: G
authors.lastname: Monneret
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D002056:Burns / Q000150:complications / Q000276:immunology*; D005260:Female; D006684:HLA-DR Antigens / Q000097:blood*; D006801:Humans; D016867:Immunocompromised Host / Q000276:immunology*; D016753:Interleukin-10 / Q000097:blood; D015850:Interleukin-6 / Q000097:blood; D008297:Male; D008875:Middle Aged; D009000:Monocytes / Q000276:immunology*; D012772:Shock, Septic / Q000209:etiology / Q000276:immunology* / Q000517:prevention & control; D016019:Survival Analysis; D015599:Trauma Severity Indices; D014409:Tumor Necrosis Factor-alpha / Q000097:blood
chemical_list: D015415:Biomarkers; D006684:HLA-DR Antigens; D015850:Interleukin-6; D014409:Tumor Necrosis Factor-alpha; D016753:Interleukin-10