Monocytic HLA-DR expression in intensive care patients: interest for prognosis and secondary infection prediction.
OBJECTIVE
To test early measurement of human leukocyte antigen-DR expression on circulating monocytes (mHLA-DR) as prognostic marker, and the trend of mHLA-DR recovery for the prediction of late secondary infection risk in a large intensive care unit population.


METHODS
Prospective, observational study over 16 mos.


METHODS
Intensive care unit in a tertiary teaching hospital.


METHODS
Simplified Acute Physiology Score II >15, age >18 yrs.


RESULTS
The mHLA-DR was measured by flow cytometry within the first 3 days and twice a week until discharge. We used a logistic regression model for outcome prediction, and a competing risk approach to test the relationship between mHLA-DR recovery (log (mHLA-DR) slope) and incidence of secondary infection. A total of 283 consecutive patients suffering from various pathologies were monitored (Simplified Acute Physiology Score II = 39, Sepsis-related Organ Failure Assessment of 5 on day 0). Early mHLA-DR was decreased in the whole population, however, more deeply in sepsis (p < .0001). Low mHLA-DR was associated with mortality in the whole population (p = .003), as in subgroups (nonseptic, neurologic, and septic), but not when adjusted on Simplified Acute Physiology Score II. In patients with a length of stay of >7 days (n = 70), the lower the slope of mHLA-DR recovery, the higher the incidence of the first secondary infection (adjusted on early mHLA-DR, p = .04).


CONCLUSIONS
For a given severity, mHLA-DR proved not to a predictive marker of outcome, but a weak trend of mHLA-DR recovery was associated with an increased risk of secondary infection. Monitoring immune functions through mHLA-DR in intensive care unit patients therefore could be useful to identify a high risk of secondary infection.
Lukaszewicz
Anne-Claire
AC
Department of Anesthesiology and Critical Care Medicine-SAMU, Laboratory of Anesthesiology, Lariboisière Hospital, AP-HP and Paris 7 Diderot University, Paris, France.
Grienay
Marion
M
Resche-Rigon
Matthieu
M
Pirracchio
Romain
R
Faivre
Valérie
V
Boval
Bernadette
B
Payen
Didier
D
D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001424:Bacterial Infections / Q000276:immunology* / Q000401:mortality / Q000628:therapy; D003428:Cross Infection / Q000276:immunology* / Q000401:mortality / Q000628:therapy; D004359:Drug Therapy, Combination; D005260:Female; D006684:HLA-DR Antigens / Q000097:blood*; D017052:Hospital Mortality; D006801:Humans; D007108:Immune Tolerance / Q000276:immunology; D007116:Immunization, Passive; D007362:Intensive Care Units; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009000:Monocytes / Q000276:immunology*; D009102:Multiple Organ Failure / Q000276:immunology / Q000401:mortality / Q000628:therapy; D053717:Pneumonia, Ventilator-Associated / Q000276:immunology / Q000401:mortality; D011237:Predictive Value of Tests; D011379:Prognosis; D012016:Reference Values; D012307:Risk Factors; D012772:Shock, Septic / Q000276:immunology* / Q000401:mortality / Q000628:therapy; D018746:Systemic Inflammatory Response Syndrome / Q000276:immunology* / Q000401:mortality / Q000628:therapy
D000900:Anti-Bacterial Agents; D006684:HLA-DR Antigens