Monocyte HLA-DR expression as predictor of poor outcome in neonates with late onset neonatal sepsis

Objectives: Down regulation of HLA-DR expression on monocytes has been reported in adult sepsis. The aims of this study were, first to evaluate monocyte HLA-DR expression in late onset neonatal infection and second to investigate the prognostic value of monocyte HLA-DR expression at onset of symptoms for the final outcome. Methods: Peripheral blood samples were taken from neonates, who were classified into three groups: late onset neonatal sepsis group (n = 40); non-infective disorders group (n = 24) and the control group (n = 25). Monocyte expression of HLA-DR was determined by flow cytometry. Results: The percentage of monocytes expressing HLA-DR was lower in neonates with late onset sepsis (p < 0.05). Of the 40 septic patients enrolled in the study, 32 survived, while 8 died. The percentage of HLA-DR expressing monocytes was significantly lower in the non-survivor sepsis group (16.6%) compared with that in the survivor sepsis group (45.2%). The optimal cutoff value of HLA-DR for predicting mortality was 30% with 87% sensitivity and 81% specificity. Patients with monocyte HLA-DR expression <= 30% had lower survival rate with a 30-fold higher risk of mortality (Odds ratio 30; 95% CI 3-295). Conclusion: According to our findings, monocyte HLA-DR expression seems to be an early predictive marker for the prognosis in late onset neonatal sepsis. (C) 2009 The British Infection Society. Published by Elsevier Ltd. All rights reserved.