Human Leukocyte Antigen – DR (HLA-DR) Isotype Expression on Monocytes as a Prognostic Marker in Patients with Sepsis in Intensive Care Unit

Abstract

Background: Sepsis is life-threatening organ dysfunction caused by a dysregulated host response to infection. Sepsis begins with excessive inflammatory state caused by pro-inflammatory cytokines which can be followed by Immunosuppression state. During the immune paralysis stage, the level of Human Leukocyte antigen -DR (HLA-DR) expression on monocytes is decreased which increase the risk of secondary infection. Objective: This study aims to evaluate the relation between the level of Human Leukocyte Antigen DR expressed on monocytes (mHLA-DR) and the clinical outcome of septic patients to use mHLA-DR as a prognostic marker for Sepsis. Methodology: Blood samples were withdrawn from 40 patients diagnosed as sepsis in Intensive Care Units in El Demerdash Hospital and 20 apparently healthy individuals. Flowcytometric analysis was used to measure the level of HLA-DR expressed on monocytes. A second sample was taken from each patient after 1 week. For long hospitalized patients, a third sample was taken after 1 more week to follow up the level of mHLA-DR. Results: Percentage of mHLA-DR in the initial sample, First and second follow up samples (median=76.5%) showed highly significant difference compared to the sample taken from control group (median=99.1%). No significant difference was found in mHLA-DR percentage between initial sample (median=76.5%), first follow up sample (median=76.55%), second follow up sample (median=55.6%). There was no statistically significant difference in the percentage of mHLA-DR in the three samples between died and alive patients. Conclusion: The level of mHLA-DR can be used as a predictive biomarker for the clinical outcome of patients with sepsis.