The role of HLA-DR expression on monocytes and Sepsis Index as
predictive sepsis biomarkers
Abstract
Sepsis is characterized by a simultaneous imbalance of hyperinflammation
and immunosuppression. The expression of HLA-DR in monocytes (MHLA-DR)
and CD64 expression in neutrophils (NCD64) are considered, respectively,
predictive and diagnostic biomarkers of infection. The ratio
NCD64/MHLA-DR has been described as a prognostic biomarker of sepsis. To
evaluate MHLA-DR expression and ratio NCD64/MHLA-DR in patients admitted
to the Intensive Care Unit (ICU) and their relationship with the
development of infection. Prospective study of 77 patients admitted to
the ICU from our hospital (HUGTiP) due to stroke or severe traumatic
brain injury. The MHLA-DR and NCD64 expression were analyzed in whole
blood samples at baseline, +3, +6, +9, +12 and +15 days after admission,
using a standardized flow cytometry protocol. During the follow-up, 71%
of patients became infected (infection without sepsis, sepsis or septic
shock). Infected patients showed – already after three days of
admission – a lower percentage of MHLA-DR+ (85.8 ± 16.22% vs. 92.5 ±
12.13%, p <0.001) than those patients than did not develop
it. Interestingly, on day +3, infected patients also had a higher ratio
NCD64/MHLA-DR (0.12 ± 0.19 vs. 0.04 ± 0.08, p <0.001) than the
non-infected ones. The immumonitoring of MHLA-DR expression and ratio
NCD64/MHLA-DR may help to evaluate those patients with higher
susceptibility to develop infection and sepsis at the ICU.