title: Up-regulation of interleukin-10 mRNA expression in peripheral leukocytes predicts poor outcome and diminished human leukocyte antigen-DR expression on monocytes in septic patients.
abstract: BACKGROUND
  None of the parameters can predict the deterioration of sepsis early enough. A new predictor allowing earlier detection of changes in septic patients' condition is indispensable.
  
  
  METHODS
  We examined whether cytokine-related mRNA expression in peripheral leukocytes, cytokine blood level, and monocyte human leukocyte antigen (HLA)-DR expression rate could be useful predictors of deterioration of sepsis. Twenty septic patients were enrolled. mRNA expression levels were quantified using real-time reverse transcriptase-polymerase chain reaction and assessed by percent changes during the first 24 h. Cytokine blood levels on admission and day 3 and monocyte HLA-DR expression rate on day 3 were also measured. Correlations between each of these parameters, and between these parameters and outcome were analyzed.
  
  
  RESULTS
  Among seven kinds of cytokines studied, only IL-10 mRNA level showed significant difference between survivors and non-survivors (P < 0.05). Mortality rate of interleukin (IL)-10 mRNA level up-regulated group was significantly higher than that of IL-10 mRNA level down-regulated group (P < 0.05). HLA-DR expression rate in non-survivors were significantly lower than that in survivors (P < 0.05). Although IL-10 blood level on day 3 significantly correlated with HLA-DR expression on day 3(r = 0.54, P < 0.05), IL-10 blood level on admission did not correlate with it. Contrarily, the degree of up-regulation of IL-10 mRNA expression during the first 24 h significantly correlated with the degree of diminished HLA-DR expression on day 3 (r = 0.78, P < 0.001).
  
  
  CONCLUSIONS
  Up-regulated IL-10 mRNA expression and diminished HLA-DR expression could be indicators of poor outcome. Furthermore, IL-10 mRNA expression measurement could predict the onset of immunoparalysis indicated by diminished HLA-DR expression earlier than IL-10 blood level measurement, leading to earlier commencement of the treatment.
authors.affiliation: Department of Emergency and Critical Care Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan. ryuzo@pf6.so-net.ne.jp
authors.forename: Ryuzo
authors.initials: R
authors.lastname: Abe
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Hirasawa
authors.forename: Shigeto
authors.initials: S
authors.lastname: Oda
authors.forename: Tomohito
authors.initials: T
authors.lastname: Sadahiro
authors.forename: Masataka
authors.initials: M
authors.lastname: Nakamura
authors.forename: Eizo
authors.initials: E
authors.lastname: Watanabe
authors.forename: Taka-Aki
authors.initials: TA
authors.lastname: Nakada
authors.forename: Masahiko
authors.initials: M
authors.lastname: Hatano
authors.forename: Takeshi
authors.initials: T
authors.lastname: Tokuhisa
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005786:Gene Expression Regulation; D006684:HLA-DR Antigens / Q000097:blood*; D006801:Humans; D016753:Interleukin-10 / Q000097:blood / Q000235:genetics*; D015850:Interleukin-6 / Q000097:blood; D007962:Leukocytes / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D009000:Monocytes / Q000276:immunology*; D012333:RNA, Messenger / Q000097:blood*; D018805:Sepsis / Q000276:immunology*; D015854:Up-Regulation
chemical_list: D006684:HLA-DR Antigens; D015850:Interleukin-6; D012333:RNA, Messenger; D016753:Interleukin-10