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Low monocyte human leukocyte antigen-DR is independently associated with nosocomial infections after septic shock.
MedLine Citation:
PMID:  20652682     Owner:  NLM     Status:  In-Process    
Abstract/OtherAbstract:
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.
Authors:
Caroline Landelle; Alain Lepape; Nicolas Voirin; Eve Tognet; Fabienne Venet; Julien Bohé; Philippe Vanhems; Guillaume Monneret
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2010-07-23
Journal Detail:
Title:  Intensive care medicine     Volume:  36     ISSN:  1432-1238     ISO Abbreviation:  Intensive Care Med     Publication Date:  2010 Nov 
Date Detail:
Created Date:  2010-10-11     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7704851     Medline TA:  Intensive Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1859-66     Citation Subset:  IM    
Affiliation:
Laboratoire de Biométrie et Biologie Evolutive, Epidémiologie et Santé Publique, CNRS, UMR 5558, Université Lyon, Lyon, France.
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Intensive Care Med. 2010 Nov;36(11):1810-2   [PMID:  20652681 ]

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