title: Changes of monocyte human leukocyte antigen-DR expression as a reliable predictor of mortality in severe sepsis.
abstract: BACKGROUND
  Many studies have shown that monocyte human leukocyte antigen-DR (mHLA-DR) expression may be a good predictor for mortality in severe septic patients. On the contrary, other studies found mHLA-DR was not a useful prognostic marker in severe sepsis. Few studies have taken changes of mHLA-DR during treatment into consideration. The objective of this study was to estimate the prognostic value of changes of mHLA-DR to predict mortality in severe sepsis.
  
  
  METHODS
  In this prospective observational study, mHLA-DR was measured by flow cytometry in peripheral blood from 79 adult patients with severe sepsis. mHLA-DR levels were determined on day 0, 3, 7 after admission to the surgical intensive care unit (SICU) with a diagnosis of severe sepsis. ΔmHLA-DR₃ and ΔmHLA-DR₇ were defined as the changes in mHLA-DR value on day 3 and day 7 compared to that on day 0. Data were compared between 28-day survivors and non-survivors. Receiver operating characteristic (ROC) curves were plotted to measure the performance and discriminating threshold of ΔmHLA-DR₃, ΔmHLA-DR₇, ΔmHLA-DR₇-₃, mHLA-DR₀, mHLA-DR₃ and mHLA-DR₇ in predicting mortality of severe sepsis.
  
  
  RESULTS
  ROC curve analysis showed that ΔmHLA-DR₃ and ΔmHLA-DR7 were reliable indicators of mortality in severe sepsis. A ΔmHLA-DR₃ value of 4.8% allowed discrimination between survivors and non-survivors with a sensitivity of 89.0% and a specificity of 93.7%; similarly, ΔmHLA-DR₇ value of 9% allowed discrimination between survivors and non-survivors with a sensitivity of 85.7% and a specificity of 90.0%. Patients with ΔmHLA-DR₃ ≤ 4.8% had higher mortality than those with ΔmHLA-DR₃ > 4.8% (71.4% vs. 2.0%, OR 125.00, 95% CI 13.93 to 1121.67); patients with ΔmHLA-DR7 ≤ 9% had higher mortality than those with ΔmHLA-DR₇ > 9% (52.9% vs. 2.0%, OR 54.00, 95% CI 5.99 to 486.08). The mean change of mHLA-DR significantly increased in the survivor group with the passage of time; from day 0 to day 3 and day 7, changes were 6.45 and 16.90 (P < 0.05), respectively.
  
  
  CONCLUSIONS
  The change of mHLA-DR over time may be a reliable predictor for mortality in patients with severe sepsis.
authors.affiliation: Department of Surgical Intensive Care Unit, The First Affiliated Hospital of Sun Yat-sen University, 58 Zhongshan Er Road, Guangzhou 510080, PR China.
authors.forename: Jian-Feng
authors.initials: JF
authors.lastname: Wu
authors.forename: Jie
authors.initials: J
authors.lastname: Ma
authors.forename: Juan
authors.initials: J
authors.lastname: Chen
authors.forename: Bin
authors.initials: B
authors.lastname: Ou-Yang
authors.forename: Min-Ying
authors.initials: MY
authors.lastname: Chen
authors.forename: Li-Fen
authors.initials: LF
authors.lastname: Li
authors.forename: Yong-Jun
authors.initials: YJ
authors.lastname: Liu
authors.forename: Ai-Hua
authors.initials: AH
authors.lastname: Lin
authors.forename: Xiang-Dong
authors.initials: XD
authors.lastname: Guan
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006684:HLA-DR Antigens / Q000378:metabolism*; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009000:Monocytes / Q000276:immunology*; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D018805:Sepsis / Q000276:immunology / Q000401:mortality*; D055815:Young Adult
chemical_list: D006684:HLA-DR Antigens