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Early prognostic markers of outcome in severe sepsis

Abstract number: 902_p1322

Lekkou A.

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Objective:

Since mortality in severe sepsis remains high, the aim of this study was to estimate the prognostic value of certain early immunological markers for the clinical outcome.

Methods:

Thirty patients (15 male, 15 female, mean age 68.5 ± 9.7 years) with severe sepsis (sepsis plus at least one organ dysfunction) were studied. The aetiology of sepsis was: pneumonia (n = 11), pyelonephritis (n = 5), intra-abdominal infection (n = 9), skin or joint infection (n = 5). The control group included 14 healthy subjects (seven male, seven female, mean age 67.9 ± 8.6 years). The percentage of monocytes expressing human leucocyte antigen-DR (CD14-HLADR) was determined by flow cytometry on admission, days (d) 3, 10, 13 and on discharge. Serum cytokine levels were determined by using ELISA (Quantikine, R & D Systems, Minneapolis) on the same days. Stepwise multiple regression and logistic regression analysis were used for statistical analysis.

Results:

Seventeen patients died 1–14 days after admission. A significant contribution to positive outcome was detected for CD14-HLADR on admission [odds ratio (OR), 1.04; 95% confidence intervals (CI), 1.00–1.09, P = 0.03], while serum interleukin-10 (IL-10) levels on day 3 (OR, 0.92; 95% CI, 0.86–0.99, P = 0.03) and IL-10 on day 10 (OR, 0.80; 95% CI, 0.65–0.98, P = 0.04) were found to be predictors of poor outcome. The strongest effect on IL-10 levels on day 10 was attributed to CD14-HLADR on day 3 (r2 = 0.4; P = 0.008) without further contribution of other cytokines (tumour necrosis factor-a, IL-4, IL-6, IL-8, transforming growth factor-b).

Conclusions:

(i) Immunosupression associated with low levels of monocyte HLA-DR expression precedes immunosupression correlated with high levels of IL-10. (ii) Monocyte HLA-DR expression is an early prognostic marker of outcome in severe sepsis and a diagnostic tool for identifying high risk patients.

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Session Details

Date: 01/08/2007
Time: 00:00-00:00
Session name: XXIst ISTH Congress
Subject:
Location: Oxford, UK
Presentation type:
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