Predicting the Outcomes of Subjects With Severe Community-Acquired Pneumonia Using Monocyte Human Leukocyte Antigen-DR.
BACKGROUND
The objective was to study the level of monocyte-human leukocyte antigen-DR (mHLA-DR), an immune function-related biomarker, at 24 h after admission, to predict the outcomes of subjects with severe pneumonia.


METHODS
Subjects with severe community-acquired pneumonia (n = 102) were included in the study. Blood samples were collected from each subject 24 h after admission. Data regarding age, sex, PaO2 /FIO2, comorbidities, occurrence of altered mental status, bacteremia, septic shock, Acute Physiology and Chronic Health Evaluation (APACHE) II score, and Sequential Organ Failure Assessment (SOFA) score within the first 24 h; the highest temperature within 24 h after admission; mechanical ventilation usage; timing of antibiotic therapy; ICU stay; and 28-d survival were collected. Expression of mHLA-DR was measured by flow cytometry.


RESULTS
APACHE II score and SOFA score were significantly higher (P < .001), whereas the mHLA-DR expression was significantly lower (P < .001) in the non-survivors than in the survivors. The outcomes at day 28 after admission were significantly associated with the APACHE II score (P = .002, odds ratio [OR] = 1.27, 95% CI 1.10-1.48), the SOFA score (P = .003, OR = 1.52, 95% CI 1.15-2.00), and mHLA-DR level (P = .01, OR = 0.91, 95% CI 0.85-0.98), as shown by logistic regression. The area under the receiver operating characteristic curve was 0.877 (95% CI 0.81-0.94, P < .001), 0.862 (95% CI 0.79-0.93, P < .001), and 0.781 (95% CI 0.69-0.87, P < .001) for APACHE II score, SOFA score, and the mHLA-DR expression, respectively. The optimal threshold for mHLA-DR level was 27.2%. Kaplan-Meier survival analysis showed that subjects with mHLA-DR ≥ 27.2% had significantly better outcomes compared with < 27.2% level (P < .001, log rank test, hazard ratio = 0.963, 95% CI 0.94-0.99).


CONCLUSIONS
mHLA-DR may be a reliable biomarker that can predict the outcomes of patients with severe community-acquired pneumonia, and 27.2% may be the cut-off value to predict the outcomes.
Emergency Department, Shanghai Tenth People's Hospital, Tongji University, School of Medicine, Shanghai, China.
Yugang
Y
Zhuang
Intensive Care Unit, Shanghai Tenth People's Hospital, Tongji University, School of Medicine, Shanghai, China.
Wenjie
W
Li
Intensive Care Unit, Shanghai Tenth People's Hospital, Tongji University, School of Medicine, Shanghai, China.
Huiqi
H
Wang
Emergency Department, Shanghai Tenth People's Hospital, Tongji University, School of Medicine, Shanghai, China.
Hu
H
Peng
Emergency Department, Shanghai Tenth People's Hospital, Tongji University, School of Medicine, Shanghai, China.
Yanqing
Y
Chen
Intensive Care Unit, Shanghai Tenth People's Hospital, Tongji University, School of Medicine, Shanghai, China.
Xiangyu
X
Zhang
Emergency Department, Shanghai Tenth People's Hospital, Tongji University, School of Medicine, Shanghai, China. chengjingao2003@126.com chenyuanzhuo021@hotmail.com.
Yuanzhuo
Y
Chen
Intensive Care Unit, Shanghai Tenth People's Hospital, Tongji University, School of Medicine, Shanghai, China. chengjingao2003@126.com chenyuanzhuo021@hotmail.com.
Chengjin
C
Gao
D018806:APACHE; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D015415:Biomarkers / Q000097:blood; D017714:Community-Acquired Infections / Q000276:immunology / Q000401:mortality; D005260:Female; D006684:HLA-DR Antigens / Q000097:blood*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009000:Monocytes / Q000276:immunology*; D011014:Pneumonia / Q000276:immunology* / Q000401:mortality*; D011237:Predictive Value of Tests; D011379:Prognosis; D012372:ROC Curve; D012720:Severity of Illness Index; D015996:Survival Rate
D015415:Biomarkers; D006684:HLA-DR Antigens
mHLA-DR; prognosis; severe pneumonia; single time point