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HLA-DR as a marker for increased risk for systemic inflammation and septic complications after cardiac surgery
Wolfgang Oczenski1, Herbert Krenn, Ruth Jilch
1Department of Anesthesia and Intensive Care and Ludwig Boltzmann Institute for Economics of Medicine in Anesthesia and Intensive Care, City of Vienna Hospital Lainz, Wolkersbergenstrasse 1, 1130, Vienna, Austria. wolfgang.oczenski@khl.magwien.gv.at
Objective:
This study investigated the predictive value of a decrease in monocyte HLA-DR expression as an early marker for postoperative SIRS and septic complications. We hypothesized that decreased HLA-DR levels in the first 24 h after cardiac surgery is not related to postoperative SIRS/sepsis. We also compared HLA-DR levels of patients with postoperative complications to those with an uncomplicated course.
Design And Setting:
Prospective observational study in a tertiary care postoperative intensive care unit.
Patients:
Eighty five consecutive patients undergoing cardiac surgery.
Measurements And Results:
Expression of HLA-DR on monocytes was analyzed by flow cytometry using a new quantitative and well standardized technique. Arterial blood samples were collected before induction of anesthesia, immediately after admission to the ICU, and on the first postoperative day. Postoperative HLA-DR expression was significantly decreased in all patients. There were no significant differences in HLA-DR expression during the first 24 h after surgery in patients with uncomplicated course and those developing SIRS or septic complications.
Conclusions:
In patients undergoing cardiac surgery the monitoring of pre- and immediate postoperative HLA-DR levels during the first 24 h does not help to predict increased risk for postoperative SIRS/sepsis or infectious complications.