单核细胞人类白细胞抗原-DR表达水平预测儿童严重脓毒症的预后

Monocytic Human Leukocyte Antigen-DR Expression Levels to Predict Outcome in Children With Severe Sepsis.

作者信息

Thangavel Nanmaaran Periyannan, Parameswaran Narayanan, Manivannan Prabhu, Ramamoorthy Jaikumar Govindaswamy

机构信息

Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.

Department of Pathology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.

出版信息

Indian Pediatr. 2024 Sep 15;61(9):845-850. Epub 2024 Jul 23.

PMID:39051313

Abstract

OBJECTIVES

To assess the association between monocytic Human Leukocyte Antigen-DR (mHLA-DR) expression and outcome in children with severe sepsis.

METHODS

Consecutive children, aged 29 days to 15 years, who were admitted with severe sepsis or septic shock in the pediatric intensive care unit (PICU) were enrolled. mHLA-DR expression [antigen bound per cell (ABC)] was assessed on two time points: between 72 to 120 hours (P1) and 121 to 168 hours (P2), of stay in PICU and the difference between the two was calculated as delta mHLA-DR. Outcomes were noted for survival, mortality and secondary infection during the hospital stay.

RESULTS

Forty-seven children with median (IQR) age 24 (10, 96) months and a median (IQR) duration of illness of 3 (3, 5) days, were enrolled consecutively. Pediatric Logistic Organ Dysfunction (PELOD) score >10 was observed in 63.8% children. 18 children succumbed. The median mHLA-DR levels (ABC) at P1 were significantly higher in children who survived as compared with those who expired (7409 vs. 2509, P = 0.004). Similarly, the median mHLA-DR levels (ABC) at P2 were higher in those who survived than the expired group (14728 vs. 2085, P = 0.001). The median delta mHLA-DR levels (ABC) were 4574 and 309 for the survived and expired group, respectively (P = 0.012). mHLA-DR at P1 (P = 0.004), mHLA-DR at P2 (P = 0.001) and delta mHLA-DR (P = 0.012) was significantly associated with mortality but not associated with secondary infection. A negative correlation was observed between PELOD score and mHLA-DR at P1 (r = -0.25, P = 0.46), at P2 (r = -0.425, P = 0.018) and delta mHLA-DR (r = -0.27, P = 0.41). The area under curve (95%CI) of mHLA-DR expression (ABC) at P2 for a cutoff of < 6631 was 0.966 (0.907, 1.0) to predict mortality in severe sepsis.

CONCLUSIONS

mHLA-DR levels were significantly lower in children who succumbed than those who survived at both time points. mHLA-DR levels can be a useful biomarker to diagnose immune-paralysed state.

摘要

目的

评估单核细胞人类白细胞抗原-DR（mHLA-DR）表达与重症脓毒症患儿预后之间的关联。

方法

纳入在儿科重症监护病房（PICU）因重症脓毒症或脓毒性休克入院的29天至15岁的连续患儿。在入住PICU的两个时间点评估mHLA-DR表达[每细胞结合抗原（ABC）]：72至120小时（P1）和121至168小时（P2），并计算两者之间的差值作为ΔmHLA-DR。记录住院期间的生存、死亡和继发感染情况。

结果

连续纳入47例患儿，中位（IQR）年龄24（10，96）个月，中位（IQR）病程3（3，5）天。63.8%的患儿儿科逻辑器官功能障碍（PELOD）评分>10。18例患儿死亡。存活患儿P1时的mHLA-DR水平（ABC）中位数显著高于死亡患儿（7409对2509，P = 0.004）。同样，存活组P2时的mHLA-DR水平（ABC）中位数高于死亡组（14728对2085，P = 0.001）。存活组和死亡组的ΔmHLA-DR水平（ABC）中位数分别为4574和309（P = 0.012）。P1时的mHLA-DR（P = 0.004）、P2时的mHLA-DR（P = 0.001）和ΔmHLA-DR（P = 0.012）与死亡率显著相关，但与继发感染无关。观察到PELOD评分与P1时的mHLA-DR（r = -0.25，P = 0.46）、P2时的mHLA-DR（r = -0.425，P = 0.018）和ΔmHLA-DR（r = -0.27，P = 0.41）之间呈负相关。P2时mHLA-DR表达（ABC）< 6631的截断值预测重症脓毒症死亡率的曲线下面积（95%CI）为0.966（0.907，1.0）。