Yugang Zhuang1, Wenjie Li2, Huiqi Wang2, Hu Peng1, Yanqing Chen1, Xiangyu Zhang2, Yuanzhuo Chen3, Chengjin Gao4. 1. Emergency Department, Shanghai Tenth People's Hospital, Tongji University, School of Medicine, Shanghai, China. 2. Intensive Care Unit, Shanghai Tenth People's Hospital, Tongji University, School of Medicine, Shanghai, China. 3. Emergency Department, Shanghai Tenth People's Hospital, Tongji University, School of Medicine, Shanghai, China. chengjingao2003@126.com chenyuanzhuo021@hotmail.com. 4. Intensive Care Unit, Shanghai Tenth People's Hospital, Tongji University, School of Medicine, Shanghai, China. chengjingao2003@126.com chenyuanzhuo021@hotmail.com.
Abstract
BACKGROUND: The objective was to study the level of monocyte-human leukocyte antigen-DR (mHLA-DR), an immune function-related biomarker, at 24 h after admission, to predict the outcomes of subjects with severe pneumonia. METHODS: Subjects with severe community-acquired pneumonia (n = 102) were included in the study. Blood samples were collected from each subject 24 h after admission. Data regarding age, sex, PaO2 /FIO2, comorbidities, occurrence of altered mental status, bacteremia, septic shock, Acute Physiology and Chronic Health Evaluation (APACHE) II score, and Sequential Organ Failure Assessment (SOFA) score within the first 24 h; the highest temperature within 24 h after admission; mechanical ventilation usage; timing of antibiotic therapy; ICU stay; and 28-d survival were collected. Expression of mHLA-DR was measured by flow cytometry. RESULTS: APACHE II score and SOFA score were significantly higher (P < .001), whereas the mHLA-DR expression was significantly lower (P < .001) in the non-survivors than in the survivors. The outcomes at day 28 after admission were significantly associated with the APACHE II score (P = .002, odds ratio [OR] = 1.27, 95% CI 1.10-1.48), the SOFA score (P = .003, OR = 1.52, 95% CI 1.15-2.00), and mHLA-DR level (P = .01, OR = 0.91, 95% CI 0.85-0.98), as shown by logistic regression. The area under the receiver operating characteristic curve was 0.877 (95% CI 0.81-0.94, P < .001), 0.862 (95% CI 0.79-0.93, P < .001), and 0.781 (95% CI 0.69-0.87, P < .001) for APACHE II score, SOFA score, and the mHLA-DR expression, respectively. The optimal threshold for mHLA-DR level was 27.2%. Kaplan-Meier survival analysis showed that subjects with mHLA-DR ≥ 27.2% had significantly better outcomes compared with < 27.2% level (P < .001, log rank test, hazard ratio = 0.963, 95% CI 0.94-0.99). CONCLUSIONS: mHLA-DR may be a reliable biomarker that can predict the outcomes of patients with severe community-acquired pneumonia, and 27.2% may be the cut-off value to predict the outcomes.
BACKGROUND: The objective was to study the level of monocyte-human leukocyte antigen-DR (mHLA-DR), an immune function-related biomarker, at 24 h after admission, to predict the outcomes of subjects with severe pneumonia. METHODS: Subjects with severe community-acquired pneumonia (n = 102) were included in the study. Blood samples were collected from each subject 24 h after admission. Data regarding age, sex, PaO2 /FIO2, comorbidities, occurrence of altered mental status, bacteremia, septic shock, Acute Physiology and Chronic Health Evaluation (APACHE) II score, and Sequential Organ Failure Assessment (SOFA) score within the first 24 h; the highest temperature within 24 h after admission; mechanical ventilation usage; timing of antibiotic therapy; ICU stay; and 28-d survival were collected. Expression of mHLA-DR was measured by flow cytometry. RESULTS: APACHE II score and SOFA score were significantly higher (P < .001), whereas the mHLA-DR expression was significantly lower (P < .001) in the non-survivors than in the survivors. The outcomes at day 28 after admission were significantly associated with the APACHE II score (P = .002, odds ratio [OR] = 1.27, 95% CI 1.10-1.48), the SOFA score (P = .003, OR = 1.52, 95% CI 1.15-2.00), and mHLA-DR level (P = .01, OR = 0.91, 95% CI 0.85-0.98), as shown by logistic regression. The area under the receiver operating characteristic curve was 0.877 (95% CI 0.81-0.94, P < .001), 0.862 (95% CI 0.79-0.93, P < .001), and 0.781 (95% CI 0.69-0.87, P < .001) for APACHE II score, SOFA score, and the mHLA-DR expression, respectively. The optimal threshold for mHLA-DR level was 27.2%. Kaplan-Meier survival analysis showed that subjects with mHLA-DR ≥ 27.2% had significantly better outcomes compared with < 27.2% level (P < .001, log rank test, hazard ratio = 0.963, 95% CI 0.94-0.99). CONCLUSIONS: mHLA-DR may be a reliable biomarker that can predict the outcomes of patients with severe community-acquired pneumonia, and 27.2% may be the cut-off value to predict the outcomes.
Authors: Jesus F Bermejo-Martin; Catia Cilloniz; Raul Mendez; Raquel Almansa; Albert Gabarrus; Adrian Ceccato; Antoni Torres; Rosario Menendez Journal: EBioMedicine Date: 2017-09-21 Impact factor: 8.143