Intensive Care Medicine

, Volume 36, Issue 11, pp 1859–1866

Low monocyte human leukocyte antigen-DR is independently associated with nosocomial infections after septic shock

Authors

  • Caroline Landelle
    • Laboratoire de Biométrie et Biologie Evolutive, Epidémiologie et Santé PubliqueCNRS, UMR 5558, Université Lyon 1; Université de Lyon
    • Hospices Civils de Lyon, Hôpital Edouard HerriotService d’Hygiène, Epidémiologie et Prévention
  • Alain Lepape
    • Hospices Civils de Lyon, Centre Hospitalier de Lyon SudService de Réanimation Chirurgicale
  • Nicolas Voirin
    • Laboratoire de Biométrie et Biologie Evolutive, Epidémiologie et Santé PubliqueCNRS, UMR 5558, Université Lyon 1; Université de Lyon
    • Hospices Civils de Lyon, Hôpital Edouard HerriotService d’Hygiène, Epidémiologie et Prévention
  • Eve Tognet
    • Hospices Civils de Lyon, Centre Hospitalier de Lyon SudService de Réanimation Médicale
  • Fabienne Venet
    • Laboratoire d’ImmunologieHôpital E. Herriot, Hospices Civils de Lyon
  • Julien Bohé
    • Hospices Civils de Lyon, Centre Hospitalier de Lyon SudService de Réanimation Médicale
  • Philippe Vanhems
    • Laboratoire de Biométrie et Biologie Evolutive, Epidémiologie et Santé PubliqueCNRS, UMR 5558, Université Lyon 1; Université de Lyon
    • Hospices Civils de Lyon, Hôpital Edouard HerriotService d’Hygiène, Epidémiologie et Prévention
    • Laboratoire d’ImmunologieHôpital E. Herriot, Hospices Civils de Lyon
Original

DOI: 10.1007/s00134-010-1962-x

Cite this article as:
Landelle, C., Lepape, A., Voirin, N. et al. Intensive Care Med (2010) 36: 1859. doi:10.1007/s00134-010-1962-x

Abstract

Purpose

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.

Keywords

mHLA-DRImmunosuppressionNosocomial infectionSepsisSeptic shock

Supplementary material

134_2010_1962_MOESM1_ESM.doc (182 kb)
Supplementary material 1 (DOC 181 kb)

Copyright information

© Copyright jointly held by Springer and ESICM 2010