Lack of recovery in monocyte human leukocyte antigen-DR expression is independently associated with the development of sepsis after major trauma

• Published in: Critical care (London, England) Vol. 14; no. 6; p. R208
• Main Authors: Cheron, Aurélie, Floccard, Bernard, Allaouchiche, Bernard, Guignant, Caroline, Poitevin, Françoise, Malcus, Christophe, Crozon, Jullien, Faure, Alexandre, Guillaume, Christian, Marcotte, Guillaume, Vulliez, Alexandre, Monneuse, Olivier, Monneret, Guillaume
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 19.11.2010; BioMed Central
• Subjects: Adult; Age; Antibodies; Data processing; Female; Flow cytometry; Follow-Up Studies; Histocompatibility antigen HLA; Histocompatibility antigens; HLA histocompatibility antigens; HLA-DR Antigens - biosynthesis; HLA-DR Antigens - genetics; HLA-DR Antigens - physiology; Hospitals; Humans; Immune response; Immunosuppression; Immunotherapy; Infection; Inflammation; Injuries; Intensive care units; Leukocytes; Male; Medical research; Medicine, Experimental; Middle Aged; Monocytes; Monocytes - immunology; Monocytes - metabolism; Prospective Studies; Recovery of Function - immunology; Regression analysis; Risk factors; Sepsis; Sepsis - etiology; Sepsis - immunology; Sepsis - metabolism; Septic shock; Trauma; Wounds and Injuries - complications; Wounds and Injuries - immunology; Wounds and Injuries - metabolism; Young Adult
• ISSN: 1364-8535; 1466-609X; 1364-8535
• DOI: 10.1186/cc9331

Major trauma is characterized by an overwhelming pro-inflammatory response and an accompanying anti-inflammatory response that lead to a state of immunosuppression, as observed after septic shock. Diminished monocyte Human Leukocyte Antigen DR (mHLA-DR) is a reliable marker of monocyte dysfunction and immunosuppression. The main objective of this study was to determine the relation between mHLA-DR expression in severe trauma patients and the development of sepsis. We conducted a prospective observational study over 23 months in a trauma intensive care unit at a university hospital. Patients with an Injury Severity Score (ISS) over 25 and age over 18 were included. mHLA-DR was assessed by flow cytometry protocol according to standardized protocol. Mann-Whitney U-test for continuous non-parametric variables, independent paired t test for continuous parametric variables and chi-square test for categorical data were used. mHLA-DR was measured three times a week during the first 14 days. One hundred five consecutive severely injured patients were monitored (ISS 38 ± 17, SAPS II 37 ± 16). Thirty-seven patients (35%) developed sepsis over the 14 days post-trauma. At days 1-2, mHLA-DR was diminished in the whole patient population, with no difference with the development of sepsis. At days 3-4, a highly significant difference appeared between septic and non-septic patients. Non- septic patients showed an increase in mHLA-DR levels, whereas septic patients did not (13,723 ± 7,766 versus 9,271 ± 6,029 antibodies per cell, p = .004). Most importantly, multivariate logistic regression analysis, after adjustment for usual clinical confounders (adjusted OR 5.41, 95% CI 1.42-20.52), revealed that a slope of mHLA-DR expression between days1-2 and days 3-4 below 1.2 remained associated with the development of sepsis. Major trauma induced an immunosuppression, characterized by a decrease in mHLA-DR expression. Importantly, after multivariate regression logistic analysis, persistent decreased expression was assessed to be in relation with the development of sepsis. This is the first study in trauma patients showing a link between the lack of immune recovery and the development of sepsis on the basis of the standardized protocol. Monitoring immune function by mHLA-DR measurement could be useful to identify trauma patients at a high risk of infection.