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Low monocyte human leukocyte antigen-DR is independently associated with nosocomial infections after septic shock
Caroline Landelle1, Alain Lepape, Nicolas Voirin
1Laboratoire de Biométrie et Biologie Evolutive, Epidémiologie et Santé Publique, CNRS, UMR 5558, Université Lyon, Lyon, France.
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.
Insights
Low monocyte human leukocyte antigen-DR (mHLA-DR) expression in septic shock patients is linked to a higher risk of secondary nosocomial infections. Persistent low mHLA-DR independently predicts infection development, highlighting its potential as a biomarker.
Area of Science:
- Immunology
- Critical Care Medicine
- Infectious Diseases
Background:
- Sepsis-induced immunosuppression increases the risk of secondary nosocomial infections (NI).
- Monocyte human leukocyte antigen-DR (mHLA-DR) expression is a potential biomarker for sepsis-induced immunosuppression.
Purpose of the Study:
- To assess the association between low mHLA-DR expression and the incidence of NI in septic shock patients.
- To determine if mHLA-DR can serve as a predictive biomarker for NI after septic shock.
Main Methods:
- Prospective, single-center observational study of 209 septic shock patients.
- mHLA-DR measured by flow cytometry at days 3-4 and 6-9 post-shock.
- Daily screening for NI at four sites; competing risk analysis used.
Main Results:
- Non-survivors and patients who developed NI had significantly lower mHLA-DR expression.
- Low mHLA-DR (≤54 at D3-4, ≤57 at D6-9) was independently associated with NI development (aHR 2.52 and 2.18, respectively).
- Association remained significant after adjusting for clinical confounders.
Conclusions:
- Persistent low mHLA-DR expression is independently associated with secondary NI in septic shock patients.
- mHLA-DR serves as a valuable biomarker for predicting NI risk in this population.
- Findings support the role of immunosuppression in sepsis-related NI.
