Concomitant Assessment of Monocyte HLA-DR Expression and Ex Vivo TNF-α Release as Markers of Adverse Outcome after Various Injuries—Insights from the REALISM Study

Journal of Clinical Medicine

on behalf of the Realism Study Group¹  Philippe Leissner²  Maxime Bodinier³  Frank Bidar³  Anne-Claire Lukaszewicz³  Julien Textoris³  Thomas Rimmelé³  Filippo Conti³  Fabienne Venet³  Guillaume Monneret³  Karen Brengel-Pesce³  Lionel K. Tan⁴  Laurence Quemeneur⁵ 

[1] ;BIOASTER, 40 Avenue Tony Garnier, 69007 Lyon, France;EA 7426 “Pathophysiology of Injury-Induced Immunosuppression” (Université Claude Bernard Lyon 1—Hospices Civils de Lyon—bioMérieux), Joint Research Unit HCL-bioMérieux, Univeristé Lyon 1, 69003 Lyon, France;GSK, 980 Great West Road, Brentford, Middlesex TW8 9GS, UK;Sanofi Pasteur, Sanofi 1541 Avenue Marcel Mérieux, 69280 Marcy l’Etoile, France;

关键词: immunosuppression;    monocyte;    HLADR;    TNF;    LPS;    sepsis;   

DOI  :  10.3390/jcm11010096

来源: DOAJ

【 摘 要 】

Intensive care unit (ICU) patients develop an altered host immune response after severe injuries. This response may evolve towards a state of persistent immunosuppression that is associated with adverse clinical outcomes. The expression of human leukocyte antigen DR on circulating monocytes (mHLA-DR) and ex vivo release of tumor necrosis factor α (TNF-α) by lipopolysaccharide-stimulated whole blood are two related biomarkers offered to characterize this phenomenon. The purpose of this study was to concomitantly evaluate the association between mHLA-DR and TNF-α release and adverse clinical outcome (i.e., death or secondary infection) after severe trauma, sepsis or surgery in a cohort of 353 ICU patients. mHLA-DR and TNF-α release was similarly and significantly reduced in patients whatever the type of injury. Persistent decreases in both markers at days 5–7 (post-admission) were significantly associated with adverse outcomes. Overall, mHLA-DR (measured by flow cytometry) appears to be a more robust and standardized parameter. Each marker can be used individually as a surrogate of immunosuppression, depending on center facilities. Combining these two parameters could be of interest to identify the most immunosuppressed patients presenting with a high risk of worsening. This last aspect deserves further exploration.

【 授权许可】

Unknown