[Role of assessment and monitoring of human leucocyte antigen-DR on CD14+ monocyte in postoperative infection in patients after orthotopic liver transplantation].
OBJECTIVE
To investigate the changes in expression level of human leucocyte antigen-DR (HLA-DR) on CD14(+) monocyte (CD14(+)/HLA-DR) in the patients after orthotopic liver transplantation, and its role in monitoring postoperative infection.


METHODS
Sixty-three patients with liver transplantation were divided into three groups, non-infection group with 47 cases, infection group with 10 cases and septic shock group with 6 cases [according to the definition of septic shock of American College of Chest Physicians/Society for Critical Care Medicine (ACCP/SCCM)]. CD14(+)/HLA-DR expression ratio was assessed with flow cytometer, and its clinical implication was evaluated by receiver operating characteristic (ROC) curve assay.


RESULTS
CD14(+)/HLA-DR expression ratio in infection group [(29.6+/-7.2)%] and septic shock group [(16.3+/-10.5)%] were significantly lower than that in non-infection group [(62.3+/-18.3)%, both P<0.01], but no significant difference of CD14(+)/HLA-DR expression ratio was found between infection group and septic shock group (P=0.128). Total area under ROC curve of CD14(+)/HLA-DR expression ratio for the infection was 0.965, its sensitivity and specificity at 36.35% cut off were 100.0% and 93.6%, respectively. Total area under ROC curve of CD14(+)/HLA-DR expression ratio to predict septic shock was 0.968, its sensitivity and specificity at 31.97% cut off were 100.0% and 87.7%, respectively. Comparing the change of CD14(+)/HLA-DR expression, it was lower in the infection group and septic shock group (P<0.05 and P<0.01), and the expression rate was lowest during period of serious infection in the two groups [infection group: (29.6+/-7.2)%, septic shock group: (16.3+/-0.5)%, all P<0.01].


CONCLUSIONS
For the patients with possible infection after liver transplantation, sequential assessment of CD14(+)/HLA-DR expression ratio would be a good marker for the judgment of patient's conditions and outcome. CD14(+)/HLA-DR expression ratio below 36.35% could be used as the prewarning value for the diagnosis of postoperative infection, and 31.97% could be used as the critical value for the diagnosis of septic shock.
Wen
Qiang
Q
Intensive Care Unit, General Hospital of Guangzhou Military Command, Guangzhou 510010, Guangdong, China.
Guo
Zhen-Hui
ZH
Su
Lei
L
Meng
Fan-Su
FS
Liu
Zhi-Feng
ZF
Qiu
Jun-Ming
JM
Huo
Feng
F
D000328:Adult; D000368:Aged; D005260:Female; D006684:HLA-DR Antigens / Q000097:blood*; D006801:Humans; D018950:Lipopolysaccharide Receptors / Q000097:blood*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D011183:Postoperative Complications / Q000097:blood / Q000175:diagnosis; D011379:Prognosis; D012772:Shock, Septic / Q000175:diagnosis* / Q000209:etiology
D006684:HLA-DR Antigens; D018950:Lipopolysaccharide Receptors