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

Abstract

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.

Inter‐laboratory assessment of flow cytometric monocyte HLA‐DR expression in clinical samples

“…In terms of functionality, monocytes with low HLA-DR expression are known to be unable to mount a pro-inflammatory response to any subsequent bacterial challenge or to properly present antigens to T cells (2,7). In terms of clinical information, decreased mHLA-DR has been shown to be predictive of both adverse outcome and septic complications after trauma, surgery, pancreatitis, burn, and septic shock (8)(9)(10)(11).…”

Measurement of monocytic HLA-DR (mHLA-DR) expression in patients with severe sepsis and septic shock: assessment of immune organ failure

“…In this issue of Intensive Care Medicine, Landelle et al put the clinical relevance of mHLA-DR measurements into a new perspective [19]. In a prospective single-centre observational trial, the authors investigated whether a diminished mHLA-DR expression is associated with an increased incidence of nosocomial infections (NI) in 209 patients with septic shock.…”

“…Importantly, Landelle et al [19] add to the mounting data from numerous groups that severe immunological impairments often occur in sepsis. These alterations are of significant clinical relevance and constitute a new organ failure that, like other organ failures, deserves assessment and most likely treatment in the future.…”

On the verge of using an immune toolbox in the intensive care unit?

“…1). Deactivation of monocytes, as assessed by a low expression of the antigen presentation apparatus [human leukocyte antigen-antigen D related (HLA-DR) test], is viewed as the most relevant marker of acquired immune suppression and has been linked to increased mortality as well as increased susceptibility to IAI [5,6]. The pitfalls of HLA-DR measurement include the need for immediate cell staining with fluorescent antibodies and for a flow cytometer and a skilled technician.…”