Changes of monocyte human leukocyte antigen-DR expression as a reliable predictor of mortality in severe sepsis

INTRODUCTION: Many studies have shown that monocyte human leukocyte antigen-DR (mHLA-DR) expression may be a good predictor for mortality in severe septic patients. On the contrary, other studies found mHLA-DR was not a useful prognostic marker in severe sepsis. Few studies have taken changes of mHLA-DR during treatment into consideration. The objective of this study was to estimate the prognostic value of changes of mHLA-DR to predict mortality in severe sepsis. METHODS: In this prospective observational study, mHLA-DR was measured by flow cytometry in peripheral blood from 79 adult patients with severe sepsis. mHLA-DR levels were determined on day 0, 3, 7 after admission to the surgical intensive care unit (SICU) with a diagnosis of severe sepsis. ΔmHLA-DR(3 )and ΔmHLA-DR(7 )were defined as the changes in mHLA-DR value on day 3 and day 7 compared to that on day 0. Data were compared between 28-day survivors and non-survivors. Receiver operating characteristic (ROC) curves were plotted to measure the performance and discriminating threshold of ΔmHLA-DR(3), ΔmHLA-DR(7), ΔmHLA-DR(7-3), mHLA-DR(0), mHLA-DR(3 )and mHLA-DR(7 )in predicting mortality of severe sepsis. RESULTS: ROC curve analysis showed that ΔmHLA-DR(3 )and ΔmHLA-DR(7 )were reliable indicators of mortality in severe sepsis. A ΔmHLA-DR(3 )value of 4.8% allowed discrimination between survivors and non-survivors with a sensitivity of 89.0% and a specificity of 93.7%; similarly, ΔmHLA-DR(7 )value of 9% allowed discrimination between survivors and non-survivors with a sensitivity of 85.7% and a specificity of 90.0%. Patients with ΔmHLA-DR(3 )≤4.8% had higher mortality than those with ΔmHLA-DR(3 )> 4.8% (71.4% vs. 2.0%, OR 125.00, 95% CI 13.93 to 1121.67); patients with ΔmHLA-DR(7 )≤9% had higher mortality than those with ΔmHLA-DR(7 )> 9% (52.9% vs. 2.0%, OR 54.00, 95% CI 5.99 to 486.08). The mean change of mHLA-DR significantly increased in the survivor group with the passage of time; from day 0 to day 3 and day 7, changes were 6.45 and 16.90 (P < 0.05), respectively. CONCLUSIONS: The change of mHLA-DR over time may be a reliable predictor for mortality in patients with severe sepsis.