Measurement of monocytic HLA-DR (mHLA-DR) expression in patients with severe sepsis and septic shock: assessment of immune organ failure

Excerpt

Sepsis is a under-recognised health care problem and a leading cause of death [1]. In an effort to reduce the high mortality from sepsis, large-scale clinical trials testing anti-inflammatory therapies, glucose control, low-dose corticosteroids, or activated protein C were performed. However, the effects of these approaches on patient mortality were rather disappointing. This may partly be due to the fact that patients were often included exclusively on the basis of a clinical diagnosis of “severe sepsis” or “septic shock” which may generate extremely heterogenous patient cohorts. When immunological interventions are tested, for example, the patient’s underlying immunological state or respective dynamics should also be considered. Recently, it was therefore proposed that a reconsideration of the general concept of both sepsis research and clinical sepsis trials seems necessary and that more disease-specific trials and studies including patients on the basis of their previously defined immunological state should be performed [2‐4]. Immunological biomarkers are thus needed that allow guidance of immunotherapies, risk stratification, and determination of which individuals might benefit from a given intervention. …