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Intensive Care Medicine

, Volume 32, Issue 8, pp 1175–1183 | Cite as

Persisting low monocyte human leukocyte antigen-DR expression predicts mortality in septic shock

  • Guillaume MonneretEmail author
  • Alain Lepape
  • Nicolas Voirin
  • Julien Bohé
  • Fabienne Venet
  • Anne-Lise Debard
  • Hélène Thizy
  • Jacques Bienvenu
  • François Gueyffier
  • Philippe Vanhems
Original

Abstract

Objective

The immediate overwhelming release of inflammatory mediators in septic shock is rapidly followed by strong anti-inflammatory responses inducing a state of immunosuppression. The patients who survive the initial hyper-inflammatory step of septic shock but subsequently die may be those who do not recover from immunosuppression. We assessed whether a low monocyte human leukocyte antigen-DR (mHLA-DR) expression, proposed as a marker of immunosuppression, is an independent predictor of mortality in patients who survived the initial 48 h of septic shock.

Design and setting

Prospective observational study performed in two adult intensive care units at a university hospital.

Patients

93 consecutive patients with septic shock.

Measurements and results

At days 1–2, mHLA-DR values (determined by flow cytometry) were not significantly different between survivors and non-survivors. A sharp difference became highly significant at days 3–4 when survivors had increased their values, while non-survivors had not (43% vs. 18%, percentage of HLA-DR positive monocyte, p < 0.001). Multivariate logistic regression analysis revealed that low mHLA-DR (< 30%) at days 3–4 remained independently associated with mortality after adjustment for usual clinical confounders, adjusted odds ratio (CI): 6.48 (95% CI: 1.62–25.93).

Conclusion

The present preliminary results show that mHLA-DR is an independent predictor of mortality in septic shock patients. Being a marker of immune failure, low mHLA-DR may provide a rationale for initiating therapy to reverse immunosuppression. After validation of the current results in multicenter studies, mHLA-DR may help to stratify patients when designing a mediator-directed therapy in a time-dependent manner.

Keywords

Septic Shock Receiver Operating Characteristic Septic Shock Patient Positive Monocyte Immune Failure 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgements

We thank J. Kingsley for greatly assisting in the preparation of this manuscript and the technical staff of the Flow Cytometry Unit (J. Baudot, C. Fernandez, M.A. Guinand, M.C. Gutowski) of the Lyon Sud University Hospital.

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Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • Guillaume Monneret
    • 1
    • 6
    Email author
  • Alain Lepape
    • 3
  • Nicolas Voirin
    • 4
  • Julien Bohé
    • 3
  • Fabienne Venet
    • 1
  • Anne-Lise Debard
    • 2
  • Hélène Thizy
    • 5
  • Jacques Bienvenu
    • 2
  • François Gueyffier
    • 5
  • Philippe Vanhems
    • 4
  1. 1.Immunology LaboratoryHôpital NeurologiqueLyonFrance
  2. 2.Immunology LaboratoryLyon-Sud University HospitalLyonFrance
  3. 3.Intensive Care UnitsLyon-Sud University HospitalLyonFrance
  4. 4.Laboratory of Epidemiology and Public Health, INSERM U271Claude Bernard UniversityLyonFrance
  5. 5.Centre d'Investigation Clinique (Clinical Research Center)INSERM and Hospices Civils de LyonLyonFrance
  6. 6.Flow Cytometry Unit, Immunology laboratoryHôpital NeurologiqueBronFrance

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