Journal
PEDIATRIC INFECTIOUS DISEASE JOURNAL
Volume 37, Issue 10, Pages 1034-1040Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/INF.0000000000001990
Keywords
HLA-DR antigens; antigens; CD14; infection; immunology; systemic inflammatory response syndrome; flow cytometry
Categories
Funding
- European Union's seventh Framework program under EC [279185]
- Fonds NutsOhra
- Erasmus MC Cost-Effectiveness Research Grant (Mrace)
- Erasmus Trustfonds via Erasmus University Rotterdam
- Flemish Agency for Innovation through Science and Technology [IWT-TBM110685]
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Background: To longitudinally study blood monocyte subset distribution and human leukocyte antigen-DR (HLA-DR) expression on monocyte subsets in children with sepsis, post-surgery and trauma in relation to nosocomial infections and mortality. Methods: In 37 healthy children and 37 critically ill children (12 sepsis, 11 post-surgery, 10 trauma and 4 admitted for other reasons)participating in a randomized controlled trial on early versus late initiation of parenteral nutritionmonocyte subset distribution and HLA-DR expression on monocyte subsets were measured by flow cytometry upon admission and on days 2, 3 and 4 of pediatric intensive care unit (PICU) stay. Results: Upon PICU admission, critically ill children had a higher proportion of classical monocytes (CD14++CD16-) than healthy children [PICU 95% (interquartile range [IQR] 88%-98%); controls, 87% (IQR 85%-90%), P < 0.001]. HLA-DR expression was significantly decreased within all monocyte subsets and at all time points, being most manifest on classical monocytes and in patients with sepsis. Percentage of HLA-DR expressing classical monocytes [upon PICU admission 67% (IQR 44%-88%); controls 95% (IQR 92%-98%), P < 0.001], as well as the HLA-DR mean fluorescence intensity [upon PICU admission 3219 (IQR 2650-4211); controls 6545 (IQR 5558-7647), P < 0.001], decreased during PICU stay. Patients who developed nosocomial infections (n = 13) or who died (n = 6) had lower HLA-DR expression on classical monocytes at day 2 (P = 0.002) and day 3 (P = 0.04), respectively. Conclusions: Monocytic HLA-DR expression decreased during PICU stay and was lower compared with controls on all examined time points, especially on classical monocytes and in children admitted for sepsis. Low HLA-DR expression on classical monocytes was associated with nosocomial infections and death.
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