Persisting low monocyte human leukocyte antigen-DR expression predicts mortality in septic shock
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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.
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).
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.
KeywordsSeptic Shock Receiver Operating Characteristic Septic Shock Patient Positive Monocyte Immune Failure
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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