Journal of Clinical Medicine (Dec 2021)

Concomitant Assessment of Monocyte HLA-DR Expression and Ex Vivo TNF-α Release as Markers of Adverse Outcome after Various Injuries—Insights from the REALISM Study

  • Frank Bidar,
  • Maxime Bodinier,
  • Fabienne Venet,
  • Anne-Claire Lukaszewicz,
  • Karen Brengel-Pesce,
  • Filippo Conti,
  • Laurence Quemeneur,
  • Philippe Leissner,
  • Lionel K. Tan,
  • Julien Textoris,
  • Thomas Rimmelé,
  • Guillaume Monneret,
  • on behalf of the Realism Study Group

DOI
https://doi.org/10.3390/jcm11010096
Journal volume & issue
Vol. 11, no. 1
p. 96

Abstract

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Intensive care unit (ICU) patients develop an altered host immune response after severe injuries. This response may evolve towards a state of persistent immunosuppression that is associated with adverse clinical outcomes. The expression of human leukocyte antigen DR on circulating monocytes (mHLA-DR) and ex vivo release of tumor necrosis factor α (TNF-α) by lipopolysaccharide-stimulated whole blood are two related biomarkers offered to characterize this phenomenon. The purpose of this study was to concomitantly evaluate the association between mHLA-DR and TNF-α release and adverse clinical outcome (i.e., death or secondary infection) after severe trauma, sepsis or surgery in a cohort of 353 ICU patients. mHLA-DR and TNF-α release was similarly and significantly reduced in patients whatever the type of injury. Persistent decreases in both markers at days 5–7 (post-admission) were significantly associated with adverse outcomes. Overall, mHLA-DR (measured by flow cytometry) appears to be a more robust and standardized parameter. Each marker can be used individually as a surrogate of immunosuppression, depending on center facilities. Combining these two parameters could be of interest to identify the most immunosuppressed patients presenting with a high risk of worsening. This last aspect deserves further exploration.

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