Early prognostic markers of outcome in severe sepsis
Abstract number: 902_p1322
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.
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.
Seventeen patients died 114 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), 1.001.09, P = 0.03], while serum interleukin-10 (IL-10) levels on day 3 (OR, 0.92; 95% CI, 0.860.99, P = 0.03) and IL-10 on day 10 (OR, 0.80; 95% CI, 0.650.98, 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).
(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."
|Session name:||XXIst ISTH Congress|
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