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Open Access 01-10-2011 | Research

Changes of monocyte human leukocyte antigen-DR expression as a reliable predictor of mortality in severe sepsis

Authors: Jian-Feng Wu, Jie Ma, Juan Chen, Bin Ou-Yang, Min-Ying Chen, Li-Fen Li, Yong-Jun Liu, Ai-Hua Lin, Xiang-Dong Guan

Published in: Critical Care | Issue 5/2011

Abstract

Introduction

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-DR_7-3, 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.

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Title: Changes of monocyte human leukocyte antigen-DR expression as a reliable predictor of mortality in severe sepsis
Authors: Jian-Feng Wu
Jie Ma
Juan Chen
Bin Ou-Yang
Min-Ying Chen
Li-Fen Li
Yong-Jun Liu
Ai-Hua Lin
Xiang-Dong Guan
Publication date: 01-10-2011
Publisher: BioMed Central
Published in: Critical Care / Issue 5/2011
Electronic ISSN: 1364-8535
DOI: https://doi.org/10.1186/cc10457

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Changes of monocyte human leukocyte antigen-DR expression as a reliable predictor of mortality in severe sepsis

Abstract

Introduction

Methods

Results

Conclusions

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusions

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