Patients with out‐of‐hospital cardiac arrest show decreased human leucocyte antigen‐DR expression on monocytes and B and T lymphocytes after return of spontaneous circulation

Abstract

Immune disorders are an important feature of patients with out‐of‐hospital cardiac arrest (OHCA) after return of spontaneous circulation (ROSC). However, the precise immune alterations in patients with OHCA that occur immediately after ROSC are unclear. In this study, we investigated human leucocyte antigen‐DR (HLA‐DR) expression on circulatory monocytes and B and T lymphocytes. Sixty‐eight consecutive patients with OHCA with ROSC >12 hours were enrolled. Clinical data and 28‐day survival were recorded. Peripheral blood samples after ROSC days 1 and 3 were analysed to evaluate HLA‐DR expression. Fifty healthy individuals were enrolled as controls. Compared with levels in healthy individuals, HLA‐DR expression on monocytes and B lymphocytes, but not on T lymphocytes, decreased on days 1 and 3 after ROSC. No significant difference in HLA‐DR expression was detected between survivors and non‐survivors on day 1. For 41 patients with expression data for days 1 and 3, HLA‐DR expression on monocytes and B lymphocytes in non‐survivors was lower than that in survivors on day 3. In non‐survivors, the mean fluorescence intensities of HLA‐DR on B lymphocytes and percentages of HLA‐DR+ T lymphocytes were lower on day 3 than on day 1. On days 1 and 3, there were significant correlations between HLA‐DR expression on monocytes and B lymphocytes and clinical indicators, such as time to ROSC, adrenaline dose, acute physiology, chronic health evaluation II and the sequential organ failure assessment. The decreases in HLA‐DR expression on circulatory monocytes and B and T lymphocytes after ROSC may be involved in the observed immunosuppression in patients with OHCA.

Monocyte subset distribution and surface expression of HLA-DR and CD14 in patients after cardiopulmonary resuscitation

“…This study strengthens the hypothesis that resuscitated patients develop early immunoparalysis, which can be characterized by downregulation of mHLA-DR expression, as previously demonstrated 32 – 34 . However, this is the first study to show that HLA-DR expression is altered primarily among classical monocytes.…”

The Relationship Between Return of Spontaneous Circulation and Neutrophil Lymphocyte and Platelet Lymphocyte Ratios in Cardiac Arrest Cases

“…L -1 olarak saptadıklarını ve SDGD sağlanan olgularda yüksek BK değerlerinin istatistiksel olarak anlamlı olduğunu bildirmişlerdir (16) . KA olgularında yapılan KPR'nin, iskemi/reperfüzyon hasarı nedeniyle sepsis benzeri sendroma ve immün sistem ile ilgili bozuklukların aktivasyonuna neden olur (17) . BK; granülositler ve non granülositler olmak üzere 2 ana grupta değerlendirilir.…”

Glucocorticoid receptor expression in patients with cardiac arrest in the early period after the return of spontaneous circulation: a prospective observational single-centre study

“…However, no study has reported the GR expression after ROSC in patients who experienced CA. Previous studies have found that the counts of circulating B and T lymphocytes, regulatory T (Treg) cells and monocytes and expression of human leucocyte antigen DR on circulatory monocytes and B and T lymphocytes are reduced 23 24. Hence, this study aimed to investigate the relationship between GR expression and immune alteration in the early period after ROSC in patients who experienced CA by observing GR expression in circulatory T and B lymphocytes, natural killer (NK) cells and Treg cells, their cell counts, and total plasma cortisol and adrenocorticotrophic hormone (ACTH) levels.…”