| Low monocyte human leukocyte antigen-DR is independently associated with nosocomial infections after septic shock. | |
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MedLine Citation:
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PMID: 20652682 Owner: NLM Status: In-Process |
Abstract/OtherAbstract:
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PURPOSE: Sepsis-induced immunosuppression is postulated to contribute to a heightened risk of nosocomial infection (NI). This prospective, single-center, observational study was conducted to assess whether low monocyte human leukocyte antigen-DR expression (mHLA-DR), proposed as a global biomarker of sepsis immunosuppression, was associated with an increased incidence of NI after septic shock. METHODS: The study included 209 septic shock patients. mHLA-DR was measured by flow cytometry at days (D) 3-4 and 6-9 after the onset of shock. After septic shock, patients were screened daily for NI at four sites (microbiologically documented pulmonary, urinary tract, bloodstream, and catheter-related infections). A competing risk approach was used to evaluate the impact of low mHLA-DR on the incidence of NI. RESULTS: At D3-4, we obtained measurements in 153 patients. Non-survivors (n = 51) exhibited lower mHLA-DR values expressed as means of fluorescence intensities than survivors (n = 102) (33 vs. 67; p < 0.001). The patients who developed NI (n = 37) exhibited lower mHLA-DR values than those without NI (n = 116) (39 vs. 65; p = 0.008). mHLA-DR ≤ 54 remained independently associated with NI occurrence after adjustment for clinical parameters (gender, simplified acute physiology score II, sepsis-related organ failure assessment, intubation, and central venous catheterization) with an adjusted hazards ratio (aHR) of 2.52 (95% CI 1.20-5.30); p = 0.02. Similarly, at D6-9, low mHLA-DR (≤ 57) remained independently associated with NI with an aHR of 2.18 (95% CI 1.04-4.59); p = 0.04. CONCLUSIONS: In septic shock patients, after adjustment with usual clinical confounders (including ventilation and central venous catheterization), persistent low mHLA-DR expression remained independently associated with the development of secondary NI. |
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Authors:
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Caroline Landelle; Alain Lepape; Nicolas Voirin; Eve Tognet; Fabienne Venet; Julien Bohé; Philippe Vanhems; Guillaume Monneret |
Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't Date: 2010-07-23 |
Journal Detail:
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Title: Intensive care medicine Volume: 36 ISSN: 1432-1238 ISO Abbreviation: Intensive Care Med Publication Date: 2010 Nov |
Date Detail:
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Created Date: 2010-10-11 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 7704851 Medline TA: Intensive Care Med Country: United States |
Other Details:
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Languages: eng Pagination: 1859-66 Citation Subset: IM |
Affiliation:
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Laboratoire de Biométrie et Biologie Evolutive, Epidémiologie et Santé Publique, CNRS, UMR 5558, Université Lyon, Lyon, France. |
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Comment In:
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Intensive Care Med. 2010 Nov;36(11):1810-2
[PMID:
20652681
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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