Cui Juanjuan, Cai Wen, Zhang Li, Wu Yueyuan, Huang Yan, Zhao Weifeng
Department of Infectious Diseases, The First Affiliated Hospital of Soochow University, Suzhou, China.
Center of Clinical Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, China.
Clin Biochem. 2025 Jan;135:110851. doi: 10.1016/j.clinbiochem.2024.110851. Epub 2024 Nov 15.
Sepsis is characterized by high incidence and mortality rates, making early recognition and risk stratification critical for preventing delayed treatment and overtreatment. This study investigated the potential of monocytic (m) HLA-DR as a diagnostic and prognostic biomarker of sepsis.
In this prospective study, we collected blood in EDTA-anticoagulated tubes within 48 h from patients diagnosed with sepsis or infection and analyzed the percentage of mHLA-DR in peripheral blood mononuclear cells, C-reactive protein, and procalcitonin within 2 h of collection. We gathered clinical and laboratory data, including sex, age, and comorbidities, calculated the number of dysfunctional organs and sequential organ failure assessment (SOFA) score, and recorded the survival status of patients with sepsis on the 30th day after admission.
mHLA-DR levels were lower in patients with sepsis (median 46.60 [interquartile range 23.86-66.51]%) than infection (75.44 [52.13-91.50]%). mHLA-DR could distinguish sepsis from infection with an area under the curve (AUC) of 0.724 (95 %CI 0.624-0.824). Decreased mHLA-DR levels have been found in septic patients with shock or secondary infections. mHLA-DR expression decreased with an increasing number of dysfunctional organs and higher SOFA score. In 30-day non-survivors, mHLA-DR levels were 26.94 (12.06-44.45)%, significantly lower than in survivors (55.20 [24.83-72.37]%). mHLA-DR predicted sepsis prognosis with an AUC of 0.750 (95 %CI 0.623-0.877). When the cut-off value was <52.29 %, the sensitivity and specificity of mHLA-DR for prognosis were 100 % and 52.83 %, respectively. The 30-day survival rate of septic patients with mHLA-DR ≥ 52.29 % was 6.798 (95 %CI 2.075-22.27) times higher than that of patients with mHLA-DR < 52.29 %.
mHLA-DR negatively correlates with the severity of sepsis and could be used as a diagnostic and prognostic biomarker for sepsis.
脓毒症的发病率和死亡率很高，因此早期识别和风险分层对于预防治疗延迟和过度治疗至关重要。本研究调查了单核细胞（m）HLA-DR作为脓毒症诊断和预后生物标志物的潜力。
在这项前瞻性研究中，我们在确诊为脓毒症或感染的患者48小时内采集乙二胺四乙酸（EDTA）抗凝管中的血液，并在采集后2小时内分析外周血单核细胞中mHLA-DR的百分比、C反应蛋白和降钙素原。我们收集了临床和实验室数据，包括性别、年龄和合并症，计算功能障碍器官的数量和序贯器官衰竭评估（SOFA）评分，并记录脓毒症患者入院后第30天的生存状态。
脓毒症患者的mHLA-DR水平（中位数46.60[四分位间距23.86 - 66.51]%）低于感染患者（75.44[52.13 - 91.50]%）。mHLA-DR能够区分脓毒症和感染，曲线下面积（AUC）为0.724（95%CI 0.624 - 0.824）。在伴有休克或继发感染的脓毒症患者中发现mHLA-DR水平降低。mHLA-DR表达随着功能障碍器官数量的增加和SOFA评分的升高而降低。在30天内死亡的患者中，mHLA-DR水平为26.94（12.06 - 44.45）%，显著低于存活患者（55.20[24.83 - 72.37]%）。mHLA-DR预测脓毒症预后的AUC为0.750（95%CI 0.623 - 0.877）。当临界值<52.29%时，mHLA-DR对预后的敏感性和特异性分别为100%和52.83%。mHLA-DR≥52.29%的脓毒症患者30天生存率比mHLA-DR<52.29%的患者高6.798（95%CI 2.075 - 22.27）倍。
mHLA-DR与脓毒症的严重程度呈负相关，可作为脓毒症的诊断和预后生物标志物。
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