Monocyte HLA-DR antigen expression characterizes clinical outcome in the trauma patient

Abstract

Immunological assessment is important to characterize the host defence response of trauma patients as infection is the most common cause of severe morbidity and late death. Sixty trauma patients were followed serially and divided into three groups: those with an uneventful recovery (n = 17), those with recovery after major sepsis (n = 27) and those who died (n = 16). The ability of peripheral blood monocytes to express the antigen HLA-DR was measured and compared to the results from 77 asymptomatic volunteers. After initial injury, there was a significant reduction from normal in the three trauma groups. It took one week for HLA-DR antigen expression to return to the normal range in the first group, three weeks in the second group, and in the third group it never returned to normal. Monocyte HLA-DR antigen expression, after incubation with lipopolysaccharide, distinguished those patients who survived from those who died. There was no difference in HLA-DR antigen expression between a high transfusion group of 31 patients who received 10 or more units of blood and a low transfusion group of 29 patients who received less than 10 units. The ability of monocytes to express HLA-DR antigen correlated directly with the clinical course in these patients and its measurement identified a group of patients at high risk of infection and death following trauma.

HLA‐DR expression and differential trafficking of monocyte subsets following low to intermediate risk surgery*

“…While decreased monocyte HLA-DR expression can be associated with increased infection rates or poor outcome in major surgery or trauma [9][10][11][12][13], we observed a substantial degree of HLA-DR reduction in our patients, whose risk of developing postoperative complications was lower than the complex major surgery previously studied. Delayed recovery of HLA-DR depression (i.e.…”

“…Human Leukocyte Antigen-DR (HLA-DR), one of the Major Histocompatibility Complex class-II proteins expressed on monocytes, macrophages and dendritic cells, is a crucial molecule for the presentation of antigen to lymphocytes and the initiation of adaptive immune responses [7,8]. Reduced levels of HLA-DR expression on blood monocytes following surgery is proposed as a potential biomarker for surgeryinduced immunosuppression and the development of postoperative infections [7,[9][10][11][12][13]. However, previous studies have focused on high risk surgery, trauma or sepsis.…”

Immunoparalysis and Adverse Outcomes from Critical Illness

“…If prolonged and severe, this state has been termed immunoparalysis. Characterized by markedly impaired innate immune function, immunoparalysis is now recognized as a predictor of morbidity and mortality for both children and adults [13][14][15][16][17][18]. Moreover, the phenomenon is often occult, is not heralded by any premorbid phenotype, and commonly occurs in patients previously thought to be immunocompetent.…”

Immunologic Consequences and Considerations of the Laparoscopic Approach

“…Monocytes present antigens to lymphocytes in the context of major histocompatibility (MHC) restriction via class II human leukocyte antigen (HLA) molecules such as HLA-DR. Decreases in the percentage of circulating monocytes that express HLA-DR are associated with a worse short-term outcome after major elective surgery and trauma [18][19][20]. Kloosterman et al reported a significant decline in the expression of HLA-DR 1 day after open cholecystectomy whereas laparoscopic removal was not associated with a change from baseline [9].…”