The mHLA-DR System in the Critically Ill
Nosocomial infections represent a major public health problem, with an incidence of about 12 % in the intensive care unit (ICU) in 2005 . Such infections are responsible for a substantial level of morbidity and mortality, and increased length of stay in the ICU and healthcare-associated costs. A new risk factor for nosocomial infection, immunosuppression, has recently been identified in critically ill patients. It is well accepted that every severe inflammatory stress state is accompanied by a hyper-inflammation state, followed by secondary immunosuppression induced by anti-inflammatory mechanisms dedicated to control the initial inflammatory response. This immunosuppressive mechanism has been found in numerous circumstances, such as sepsis, severe trauma, or invasive surgery. In the absence of clinical signs of immune status, various biological parameters have been evaluated. Among the biomarkers studied, monocyte expression of human leukocyte antigen (HLA-DR), or mHLA-DR, has provided the most satisfactory results in representing immune function. The goal of this review is to present an overview of mHLA-DR in the ICU, in terms of its prognostic value for mortality and secondary infections and its potential in the monitoring of new immune treatments in septic shock.
KeywordsSeptic Shock Human Leukocyte Antigen Sequential Organ Failure Assessment Severe Acute Pancreatitis Granulocyte Macrophage Colony Stimulate Factor
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