Monocyte HLA-DR expression as predictor of poor outcome in neonates with late onset neonatal sepsis.
OBJECTIVE
Down regulation of HLA-DR expression on monocytes has been reported in adult sepsis. The aims of this study were, first to evaluate monocyte HLA-DR expression in late onset neonatal infection and second to investigate the prognostic value of monocyte HLA-DR expression at onset of symptoms for the final outcome.


METHODS
Peripheral blood samples were taken from neonates, who were classified into three groups: late onset neonatal sepsis group (n=40); non-infective disorders group (n=24) and the control group (n=25). Monocyte expression of HLA-DR was determined by flow cytometry.


RESULTS
The percentage of monocytes expressing HLA-DR was lower in neonates with late onset sepsis (p<0.05). Of the 40 septic patients enrolled in the study, 32 survived, while 8 died. The percentage of HLA-DR expressing monocytes was significantly lower in the non-survivor sepsis group (16.6%) compared with that in the survivor sepsis group (45.2%). The optimal cutoff value of HLA-DR for predicting mortality was 30% with 87% sensitivity and 81% specificity. Patients with monocyte HLA-DR expression </=30% had lower survival rate with a 30-fold higher risk of mortality (Odds ratio 30; 95% CI 3-295).


CONCLUSIONS
According to our findings, monocyte HLA-DR expression seems to be an early predictive marker for the prognosis in late onset neonatal sepsis.
Genel
Ferah
F
Department of Pediatrics, Dr. Behçet Uz Children's Hospital, Izmir, Turkey. ferahgen@yahoo.com
Atlihan
Fusun
F
Ozsu
Elif
E
Ozbek
Erhan
E
D005260:Female; D005434:Flow Cytometry; D006684:HLA-DR Antigens / Q000096:biosynthesis*; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D009000:Monocytes / Q000276:immunology*; D011379:Prognosis; D018805:Sepsis / Q000175:diagnosis* / Q000276:immunology* / Q000401:mortality; D016896:Treatment Outcome
D006684:HLA-DR Antigens