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Decreased Human Leukocyte Antigen DR on Circulating Monocytes Expression After Severe Pediatric Trauma: An
Fleur Cour-Andlauer1, Brenda M Morrow2,3, Mignon McCulloch2,3
1Hospices Civils de Lyon, Paediatric Intensive Care Unit, Mother and Children University Hospital, Bron, France.
Insights
Pediatric trauma significantly reduces human leukocyte antigen-DR (HLA-DR) expression on monocytes. While not linked to infection, low HLA-DR levels at Day 3 may predict worse outcomes in children.
Area of Science:
- Immunology
- Pediatric Critical Care
- Trauma Surgery
Background:
- Major trauma in adults impairs immune function, evidenced by reduced human leukocyte antigen-DR (HLA-DR) expression on monocytes.
- Pediatric data on immune dysfunction following trauma are lacking.
- This study investigates HLA-DR expression kinetics in pediatric trauma patients.
Purpose of the Study:
- To describe the changes in HLA-DR expression on monocytes after major pediatric trauma.
- To explore the relationship between HLA-DR expression and patient outcomes, including secondary infections and mortality.
Main Methods:
- Prospective observational study conducted in South Africa.
- Included children aged 1 month to 13 years with severe brain trauma or Injury Severity Score ≥ 16.
- Monitored HLA-DR expression on monocytes at Days 1-2, 3-4, and 8-9 post-injury.
Main Results:
- A marked decrease in monocyte HLA-DR expression was observed on Day 1 post-trauma.
- HLA-DR expression significantly increased from Day 1 to Day 8.
- While not statistically associated with secondary infections, lower HLA-DR levels at Day 3 correlated with higher mortality or prolonged hospitalization.
Conclusions:
- Severe pediatric trauma causes a profound, early reduction in monocyte HLA-DR expression.
- This immune alteration was not definitively linked to secondary infections in this cohort.
- Day 3 monocyte HLA-DR levels may serve as a prognostic marker for adverse outcomes in pediatric trauma patients.
Objectives:
Major trauma in adults induces immune dysfunction, with diminished expression of human leukocyte antigen-DR on circulating monocytes. No pediatric data are available. This study described the kinetics of human leukocyte antigen-DR on circulating monocytes following major pediatric trauma and relationships between human leukocyte antigen-DR on circulating monocytes and outcomes.
Design:
Prospective observational study.
Setting:
PICU and trauma unit at a tertiary-care university hospital in South Africa.
Patients:
Children between 1 month and 13 years hospitalized for severe brain trauma or trauma with an Injury Severity Score greater than or equal to 16, from November 2016 to March 2017.
Interventions:
None.
Measurements And Main Results:
We included 36 children. Median (interquartile range) age and Injury Severity Score were 7 years (4.9-10.5 yr) and 25 years (22.7-30 yr), respectively. Blood samples (n = 83) for standardized human leukocyte antigen-DR on circulating monocytes measurement were collected at days 1-2, 3-4, and 8-9 after injury (D1, D3, and D8, respectively). On D1, median (interquartile range) human leukocyte antigen-DR on circulating monocytes was markedly reduced relative to normal values (7,031 [5,204-11,201] antibodies per cell). There was a significant increase in human leukocyte antigen-DR on circulating monocytes from D1 to D8. Although all patients with secondary infections (n = 8; 22%) had human leukocyte antigen-DR on circulating monocytes less than 15,000 antibodies per cell at D3, human leukocyte antigen-DR on circulating monocytes levels were not associated with the occurrence of secondary infections (p = 0.22). At D3, human leukocyte antigen-DR on circulating monocytes was significantly higher in patients discharged home (n = 21) by Day 30 after trauma compared with those who died or were still hospitalized (n = 14) (p = 0.02).
Conclusions:
Pediatric severe trauma induced an early and dramatic decrease in human leukocyte antigen-DR on circulating monocytes expression. This alteration of innate immunity was not associated with the occurrence of secondary infection, possibly due to a lack of statistical power. However, human leukocyte antigen-DR on circulating monocytes at Day 3 is a potential indicator of those at high risk of secondary infection and worse outcomes.
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