Reduced Monocytic Human Leukocyte Antigen-DR Expression Indicates Immunosuppression in Critically Ill COVID-19 Patients

Spinetti, Thibaud; Hirzel, Cédric; Fux, Michaela; Walti, Laura N; Schober, Patrick; Stueber, Frank; Luedi, Markus M.; Schefold, Joerg C.

doi:10.1213/ane.0000000000005044

Cited by 72 publications

(76 citation statements)

References 28 publications

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“…Four were based on values obtained using a standardized protocol and results are expressed as the number of antibodies bound per cell (AB/C). Most importantly, these independent studies from different groups located in different countries (Bern‐CH, Nijmegen‐NL, Limoges‐F, Lyon‐F) provided extremely homogenous results (27–30). Initial mHLA‐DR values for ICU COVID‐19 patients were around 10,000 AB/C, which was lower than controls (>15,000 AB/C) but not as low as that found in septic shock (around 5,000 AB/C).…”

Section: Clinical Results In Covid‐19 Patientsmentioning

confidence: 99%

Monocyte HLA‐DR Measurement by Flow Cytometry in COVID‐19 Patients: An Interim Review

et al. 2020

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Several months after the sudden emergence of SARS‐CoV‐2 and COVID‐19, the understanding of the appropriate host immune response to a virus totally unknown of human immune surveillance is still of major importance. By international definition, COVID‐19 falls in the scope of septic syndromes (organ dysfunction due to dysregulated host response to an infection) in which immunosuppression is a significant driver of mortality. Sepsis‐induced immunosuppression is mostly defined and monitored by the measurement of decreased expression of HLA‐DR molecules on circulating monocytes (mHLA‐DR). In this interim review, we summarize the first mHLA‐DR results in COVID‐19 patients. In critically ill patients, results homogenously indicate a decreased mHLA‐DR expression, which, along with profound lymphopenia and other functional alterations, is indicative of a status of immunosuppression. © 2020 International Society for Advancement of Cytometry

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Section: Clinical Results In Covid‐19 Patientsmentioning

confidence: 99%

Monocyte HLA‐DR Measurement by Flow Cytometry in COVID‐19 Patients: An Interim Review

et al. 2020

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“…Additionally, Hoffmann et al ( 44 ) found that reduced monocytic human leukocyte antigen-DR (HLA-DR), led by SIDS, could predict SAP independently. During the novel coronavirus 2019 pandemic, a new study found that decrease depression of monocytic HLA-DR in critically ill patients may lead to immunosuppression ( 46 ). Thus, we hypothesized that SIDS would decrease the expression of monocytic HLA-DR and compensatively increase monocyte counts.…”

Section: Discussionmentioning

confidence: 99%

High Monocyte-To-Lymphocyte Ratio Is Associated With Stroke-Associated Pneumonia

et al. 2020

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Purpose: Stroke-associated pneumonia (SAP), a common complication in acute ischemic stroke (AIS) patients, is associated with poor prognosis after AIS. Inflammation plays an important role in the development of SAP. In this study, we aimed to explore the association between the monocyte-to-lymphocyte ratio (MLR) and SAP in AIS patients. Methods: We continuously enrolled 972 AIS patients. SAP was diagnosed by two trained neurologists and confirmed by radiography, meeting the modified Centers for Disease Control and Prevention criteria. MLR values were measured for all participants, and all patients were evenly classified into three tertiles according to the MLR levels. We used the values that Youden's index max points corresponded to represent the optimal cutoffs, which represented the balance in sensitivity and specificity. Results: 104 (10.7%) patients were diagnosed with SAP. SAP patients showed a significant increased ( P < 0.001) MLR when compared with non-SAP. The optimal cutoff points of MLR were (T1) <0.2513, (T2) 0.2513–0.3843, and (T3) > 0.3843. The incidence of SAP was significantly higher in the third MLR tertile than the first and second MLR tertiles (21.7 vs. 4 vs. 6.5%, respectively, P < 0.001). After adjusting for confounding and risk factors, multivariate regression analysis showed that the third MLR tertile was an independent variable predicting the occurrence of SAP (odds ratio = 3.503, 95%CI = 1.066–11.515, P = 0.039). Conclusions: Our study showed that higher MLR was significantly associated with SAP in AIS patients. MLR is beneficial for clinicians to recognize patients with a high risk of SAP at an early stage and is an effective way to improve clinical care of SAP patients. Higher MLR could be a helpful and valid biomarker for predicting SAP in clinical practice.

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“…Perhaps, successful completion of a clinical trial for PD-L1 in sepsis could also be tested as a therapy for COVID-19–related immunosuppression. Given results obtained by Spinetti et al, 1 this seems to be a relevant approach to diminishing morbidity and mortality among ICU patients with COVID-19. Another potential benefit is utilization of HLA-DR variants as a prognostic tool to identify individuals with a higher risk for severe infection and hospitalization due to COVID-19.…”

mentioning

confidence: 88%

“…Despite remarkable progress in understanding the immune response to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV2), optimal management of immune function during severe viral infections remains a major issue among critically ill patients. In this issue of Anesthesia & Analgesia , a clinical study by Spinetti et al 1 revealed serious concerns about the development of immunosuppression among coronavirusdisease2019 (COVID-19) patients requiring hospitalization in an intensive care unit (ICU). A significant number of patients appeared to develop immune dysfunction, as evidenced by reduced amounts of monocytic human leukocyte antigen-DR (mHLA-DR).…”

mentioning

confidence: 99%

Human Leukocyte Antigen-DR Deficiency and Immunosuppression-Related End-Organ Failure in SARS-CoV2 Infection

Żmijewski¹,

Pittet

2020

Anesthesia &Amp; Analgesia

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Reduced Monocytic Human Leukocyte Antigen-DR Expression Indicates Immunosuppression in Critically Ill COVID-19 Patients

Cited by 72 publications

References 28 publications

Monocyte HLA‐DR Measurement by Flow Cytometry in COVID‐19 Patients: An Interim Review

Monocyte HLA‐DR Measurement by Flow Cytometry in COVID‐19 Patients: An Interim Review

High Monocyte-To-Lymphocyte Ratio Is Associated With Stroke-Associated Pneumonia

Human Leukocyte Antigen-DR Deficiency and Immunosuppression-Related End-Organ Failure in SARS-CoV2 Infection

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