title: Low monocyte human leukocyte antigen-DR is independently associated with nosocomial infections after septic shock.
abstract: OBJECTIVE
  Sepsis-induced immunosuppression is postulated to contribute to a heightened risk of nosocomial infection (NI). This prospective, single-center, observational study was conducted to assess whether low monocyte human leukocyte antigen-DR expression (mHLA-DR), proposed as a global biomarker of sepsis immunosuppression, was associated with an increased incidence of NI after septic shock.
  
  
  METHODS
  The study included 209 septic shock patients. mHLA-DR was measured by flow cytometry at days (D) 3-4 and 6-9 after the onset of shock. After septic shock, patients were screened daily for NI at four sites (microbiologically documented pulmonary, urinary tract, bloodstream, and catheter-related infections). A competing risk approach was used to evaluate the impact of low mHLA-DR on the incidence of NI.
  
  
  RESULTS
  At D3-4, we obtained measurements in 153 patients. Non-survivors (n = 51) exhibited lower mHLA-DR values expressed as means of fluorescence intensities than survivors (n = 102) (33 vs. 67; p < 0.001). The patients who developed NI (n = 37) exhibited lower mHLA-DR values than those without NI (n = 116) (39 vs. 65; p = 0.008). mHLA-DR ≤ 54 remained independently associated with NI occurrence after adjustment for clinical parameters (gender, simplified acute physiology score II, sepsis-related organ failure assessment, intubation, and central venous catheterization) with an adjusted hazards ratio (aHR) of 2.52 (95% CI 1.20-5.30); p = 0.02. Similarly, at D6-9, low mHLA-DR (≤ 57) remained independently associated with NI with an aHR of 2.18 (95% CI 1.04-4.59); p = 0.04.
  
  
  CONCLUSIONS
  In septic shock patients, after adjustment with usual clinical confounders (including ventilation and central venous catheterization), persistent low mHLA-DR expression remained independently associated with the development of secondary NI.
authors.affiliation: Laboratoire de Biométrie et Biologie Evolutive, Epidémiologie et Santé Publique, CNRS, UMR 5558, Université Lyon, Lyon, France.
authors.forename: Caroline
authors.initials: C
authors.lastname: Landelle
authors.forename: Alain
authors.initials: A
authors.lastname: Lepape
authors.forename: Nicolas
authors.initials: N
authors.lastname: Voirin
authors.forename: Eve
authors.initials: E
authors.lastname: Tognet
authors.forename: Fabienne
authors.initials: F
authors.lastname: Venet
authors.forename: Julien
authors.initials: J
authors.lastname: Bohé
authors.forename: Philippe
authors.initials: P
authors.lastname: Vanhems
authors.forename: Guillaume
authors.initials: G
authors.lastname: Monneret
mesh_terms: D000368:Aged; D003428:Cross Infection / Q000503:physiopathology*; D005260:Female; D006684:HLA-DR Antigens / Q000097:blood* / Q000276:immunology; D006801:Humans; D007165:Immunosuppression Therapy; D008297:Male; D008875:Middle Aged; D009000:Monocytes / Q000276:immunology*; D011446:Prospective Studies; D012772:Shock, Septic / Q000503:physiopathology*
chemical_list: D006684:HLA-DR Antigens