Intensive Care Medicine

, 37:1438

Profound and persistent decrease of circulating dendritic cells is associated with ICU-acquired infection in patients with septic shock

  • D. Grimaldi
  • S. Louis
  • F. Pène
  • G. Sirgo
  • C. Rousseau
  • Y. E. Claessens
  • L. Vimeux
  • A. Cariou
  • J. P. Mira
  • A. Hosmalin
  • J. D. Chiche
Original

DOI: 10.1007/s00134-011-2306-1

Cite this article as:
Grimaldi, D., Louis, S., Pène, F. et al. Intensive Care Med (2011) 37: 1438. doi:10.1007/s00134-011-2306-1

Abstract

Purpose

Septic shock induces a decrease in dendritic cells (DCs) that may contribute to sepsis-induced immunosuppression. We analyzed the time course of circulating DCs in patients with septic shock and its relation to susceptibility to intensive care unit (ICU)-acquired infections.

Methods

We enrolled adult patients with septic shock (n = 43), non-septic shock (n = 29), and with sepsis without organ dysfunction (n = 16). Healthy controls (n = 16) served as reference. Blood samples were drawn on the day of shock (day 1), then after 3 and 7 days. Myeloid (mDC) and plasmacytoid (pDC) DCs were counted by flow cytometry. Cell surface HLA-DR expression was analyzed in both DC subsets.

Results

At day 1, median mDC and pDC counts were dramatically lower in septic shock patients as compared to healthy controls (respectively, 835 mDCs and 178 pDCs/ml vs. 19,342 mDCs and 6,169 pDCs/ml; P < 0.0001) but also to non-septic shock and sepsis patients (P < 0.0001). HLA-DR expression was decreased in both mDCs and pDCS within the septic shock group as compared to healthy controls. DC depletion was sustained for at least 7 days in septic shock patients. Among them, 10/43 developed ICU-acquired infections after a median of 9 [7.5–11] days. At day 7, mDC counts increased in patients devoid of secondary infections, whereas they remained low in those who subsequently developed ICU-acquired infections.

Conclusion

Septic shock is associated with profound and sustained depletion of circulating DCs. The persistence of low mDC counts is associated with the development of ICU-acquired infections, suggesting that DC depletion is a functional feature of sepsis-induced immunosuppression.

Keywords

Septic shockDendritic cellsSepsis-induced immunosuppressionNosocomial infection

Supplementary material

134_2011_2306_MOESM1_ESM.ppt (952 kb)
Supplementary material 1 (PPT 952 kb)

Copyright information

© Copyright jointly held by Springer and ESICM 2011

Authors and Affiliations

  • D. Grimaldi
    • 1
    • 2
    • 3
    • 4
  • S. Louis
    • 2
    • 3
    • 4
  • F. Pène
    • 1
    • 2
    • 3
    • 4
  • G. Sirgo
    • 2
    • 3
    • 4
  • C. Rousseau
    • 2
    • 3
    • 4
  • Y. E. Claessens
    • 2
    • 3
    • 4
    • 5
  • L. Vimeux
    • 2
    • 3
    • 4
  • A. Cariou
    • 1
    • 2
  • J. P. Mira
    • 1
    • 2
    • 3
    • 4
  • A. Hosmalin
    • 2
    • 3
    • 4
  • J. D. Chiche
    • 1
    • 2
    • 3
    • 4
  1. 1.Medical Intensive Care UnitHôpital CochinParisFrance
  2. 2.Université Paris-DescartesParisFrance
  3. 3.INSERM, U1016, Institut CochinParisFrance
  4. 4.CNRS, UMR 8104ParisFrance
  5. 5.Emergency DepartmentHôpital Cochin, AP-HPParisFrance