HLA-DR as a marker for increased risk for systemic inflammation and septic complications after cardiac surgery

Oczenski, Wolfgang; Krenn, Herbert; Jilch, Ruth; Watzka, Stefan B.; Waldenberger, Ferdinand; Köller, Ursula; Schwarz, Sebastian; Fitzgerald, Robert D.

doi:10.1007/s00134-003-1826-8

Cited by 63 publications

(34 citation statements)

References 18 publications

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“…Late recovery of HLA-DR expression is certainly beyond this discriminatory 'window'. Our conclusion is consistent with the report by Oczenski et al [42], who questioned the predictive value of decreased HLA-DR levels after demonstrating no difference in HLA-DR depression between patients who developed systemic inflammatory response syndrome and those who did not, 24 h after cardiac surgery.…”

Section: Discussionsupporting

confidence: 93%

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

et al. 2009

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SummaryReduced HLA-DR expression on monocytes has been suggested as a predictive marker of immunosuppression following very high risk surgery, but there are few reports in lower risk surgery. In 32 patients undergoing low to intermediate risk surgery, blood samples were analysed by flow cytometry for HLA-DR expression and numbers in both CD14 high and CD14 low CD16+ monocyte subsets. The numbers of CD14high monocytes increased at 24 h (mean (SD), 5.0 (2.2) vs 7.6 (3.9) · 10 5 cells.ml )1 ; p < 0.01) while CD14 low CD16+ monocytes decreased (0.68 (0.36) vs 0.44 (0.36) · 10 5 cells.ml; p < 0.01). HLA-DR expression was significantly reduced in both subsets by 24 h (mean (SD) fluorescent intensity 440 (310) vs 160 (130) for CD14 high and 1000 (410) vs 560 (380) for CD14 low CD16+ subsets; p < 0.01). This reduction of monocyte HLA-DR expression 24 h following lower risk surgery raises questions about the purported clinical utility of this biomarker as an early predictor of postoperative complications. Our results also suggest that surgery induces significant trafficking (i.e. mobilisation, margination and extravasation) of monocyte subsets, and that monocyte HLA-DR depression is the result of a down-regulatory phenomenon (decreased protein expression on each cell) rather than the differential trafficking of monocyte subsets.

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Section: Discussionsupporting

confidence: 93%

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

et al. 2009

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“…2). Another report of the same test, however, described the failure of monocytic HLA-DR to discriminate patients with postoperative complications (25 ). The questions raised by such conflicting results may be answered by multicenter trials now underway in which the new, standardized test is being performed in parallel with laboratory-specific tests for monocytic HLA-DR expression.…”

Section: Discussionmentioning

confidence: 99%

“…Consequently, promising studies are underway to investigate the use of immunostimulatory agents, including interferon-␥, granulocyte-macrophage colonystimulating factor, and glutamine-rich nutrition, in patients with severe and prolonged down-regulation of monocytic HLA-DR expression (16 -22 ). Controversial results regarding the diagnostic value of monocytic HLA-DR expression have also been reported, however (23)(24)(25). One explanation for the controversial results may be methodologic differences.…”

mentioning

confidence: 99%

Monitoring Temporary Immunodepression by Flow Cytometric Measurement of Monocytic HLA-DR Expression: A Multicenter Standardized Study

et al. 2005

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“…Reduced monocyte expression of the HLA class II DR molecule characterizes patients with septic shock with a poor prognosis, while recovery to normal is seen in those who survive. [16][17][18][19][20][21][22][23][24][25] The profound reduction in HLA-DR expression and a reduced ability in vitro to produce TNF-␣ following lipopolysaacharide stimulation is reflected in the fact that patients with septic shock usually succumb to repeated bacterial and opportunistic infections. 21 Recently, reduced monocyte HLA-DR expression has been reported in patients with septic decompensation of acute-on-chronic liver failure.…”

Section: S Ystemic Inflammatory Response Syndrome (Sirs) Ismentioning

confidence: 99%

Reduced monocyte HLA-DR expression: A novel biomarker of disease severity and outcome in acetaminophen-induced acute liver failure

et al. 2006

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Acute liver failure (ALF) shares striking similarities with septic shock where a decrease in HLA-DR expression on monocytes is associated with disease severity and predicts outcome. We investigated monocyte HLA-DR expression in ALF in relation to inflammatory mediator levels and clinical outcome. Monocyte HLA-DR expression was determined in 50 patients with acetaminophen-induced ALF (AALF) and 20 non-acetaminophen-induced ALF (NAALF). AALF patients were divided into dead/transplanted (AALF-NS, n ‫؍‬ 26) and spontaneous survivors (AALF-S, n ‫؍‬ 24). Fifty patients with chronic liver disease (CLD) and 50 healthy volunteers served as controls. Monocyte HLA-DR expression was determined by double-color flow-cytometry with monoclonal antibodies detecting HLA-DR and monocyte specific CD14. Serum levels of interleukin (IL) -4, -6, -10, tumor necrosis factor (TNF)-␣ and interferon (IFN)-␥ were concomitantly measured by ELISA. Compared to healthy volunteers (75%) and CLD (67%) monocyte HLA-DR percentage expression was lower in AALF (15%, P < .001) and NAALF (22 %, P < .001). Compared to AALF-S, AALF-NS had lower monocyte HLA-DR % (11% vs. 36%, P < .001) and higher levels of IL-4, IL-6, IL-10 and TNF-␣ (P < .001). HLA-DR percentage negatively correlated with INR, blood lactate, pH and levels of encephalopathy (r ‫؍‬ ؊0.8 to ؊0.5, P < .01), IL-10 (r ‫؍‬ ؊0.8, P < .0001), TNF-␣ (r ‫؍‬ ؊0.4, P ‫؍‬ .02). HLA-DR percentage level <15% has a 96% sensitivity and 100% specificity and 98% accuracy in predicting poor prognosis. In conclusion, the strong relationship of monocyte HLA-DR expression with indices of disease severity, mediators of inflammation and outcome indicates a key role for this molecule as a biomarker of disease severity and prognosis. (HEPATOLOGY 2006;44:34-43.)

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HLA-DR as a marker for increased risk for systemic inflammation and septic complications after cardiac surgery

Abstract: In patients undergoing cardiac surgery the monitoring of pre- and immediate postoperative HLA-DR levels during the first 24 h does not help to predict increased risk for postoperative SIRS/sepsis or infectious complications.

Cited by 63 publications

References 18 publications

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

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

Monitoring Temporary Immunodepression by Flow Cytometric Measurement of Monocytic HLA-DR Expression: A Multicenter Standardized Study

Reduced monocyte HLA-DR expression: A novel biomarker of disease severity and outcome in acetaminophen-induced acute liver failure

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