A decrease of human leucocyte antigen-DR expression on monocytes in peripheral blood predicts stroke-associated...

Area of Science:

• Immunology
• Neurology
• Critical Care Medicine

Background:

• Stroke patients admitted to neurological intensive care units (NICUs) are susceptible to secondary infections.
• Assessing immune status is crucial for predicting outcomes in critically ill stroke patients.

Purpose of the Study:

• To investigate dynamic changes in monocyte human leucocyte antigen-DR (HLA-DR) expression post-stroke.
• To evaluate HLA-DR's predictive value for stroke-associated infection (SAI).
• To correlate HLA-DR expression with stroke severity and patient prognosis.

Main Methods:

• Serial blood sampling and monocyte HLA-DR expression measurement via flow cytometry in 53 stroke patients and 39 controls.
• Clinical data collection including NIHSS, APACHEII, and GCS scores.
• Follow-up for infection development and survival status within 2 weeks.

Main Results:

• Monocyte HLA-DR expression was significantly lower in stroke patients compared to controls throughout the study period (P < 0.001).
• Lower HLA-DR expression on days 4, 6, and 14 correlated with infection development (P < 0.01).
• Day 2 HLA-DR expression <57.83% predicted SAI with high sensitivity (95.8%) and specificity (79.3%), AUC=0.907 (P=0.000).
• Progressively decreasing HLA-DR expression correlated with poorer prognosis and higher NIHSS scores (P < 0.01).

Conclusions:

• Monocyte HLA-DR expression undergoes dynamic changes in critically ill stroke patients.
• Sustained low HLA-DR expression is linked to increased infection risk and adverse outcomes.
• Monitoring HLA-DR levels offers a potential tool for early identification of high-risk stroke patients for infection.