Monocytic Human Leukocyte Antigen-DR Expression Levels to Predict Outcome in Children With Severe Sepsis.

IF 1.7 4区医学 Q2 PEDIATRICS Indian pediatrics Pub Date : 2024-09-15 Epub Date: 2024-07-23

Nanmaaran Periyannan Thangavel, Narayanan Parameswaran, Prabhu Manivannan, Jaikumar Govindaswamy Ramamoorthy

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Abstract

Objectives: To assess the association between monocytic Human Leukocyte Antigen-DR (mHLA-DR) expression and outcome in children with severe sepsis.

Methods: Consecutive children, aged 29 days to 15 years, who were admitted with severe sepsis or septic shock in the pediatric intensive care unit (PICU) were enrolled. mHLA-DR expression [antigen bound per cell (ABC)] was assessed on two time points: between 72 to 120 hours (P1) and 121 to 168 hours (P2), of stay in PICU and the difference between the two was calculated as delta mHLA-DR. Outcomes were noted for survival, mortality and secondary infection during the hospital stay.

Results: Forty-seven children with median (IQR) age 24 (10, 96) months and a median (IQR) duration of illness of 3 (3, 5) days, were enrolled consecutively. Pediatric Logistic Organ Dysfunction (PELOD) score >10 was observed in 63.8% children. 18 children succumbed. The median mHLA-DR levels (ABC) at P1 were significantly higher in children who survived as compared with those who expired (7409 vs. 2509, P = 0.004). Similarly, the median mHLA-DR levels (ABC) at P2 were higher in those who survived than the expired group (14728 vs. 2085, P = 0.001). The median delta mHLA-DR levels (ABC) were 4574 and 309 for the survived and expired group, respectively (P = 0.012). mHLA-DR at P1 (P = 0.004), mHLA-DR at P2 (P = 0.001) and delta mHLA-DR (P = 0.012) was significantly associated with mortality but not associated with secondary infection. A negative correlation was observed between PELOD score and mHLA-DR at P1 (r = -0.25, P = 0.46), at P2 (r = -0.425, P = 0.018) and delta mHLA-DR (r = -0.27, P = 0.41). The area under curve (95%CI) of mHLA-DR expression (ABC) at P2 for a cutoff of < 6631 was 0.966 (0.907, 1.0) to predict mortality in severe sepsis.

Conclusions: mHLA-DR levels were significantly lower in children who succumbed than those who survived at both time points. mHLA-DR levels can be a useful biomarker to diagnose immune-paralysed state.

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预测严重败血症患儿预后的单核细胞人类白细胞抗原-DR 表达水平

目的评估严重脓毒症患儿单核细胞人类白细胞抗原-DR（mHLA-DR）表达与预后之间的关系：mHLA-DR 表达（每细胞抗原结合率 (ABC)）在两个时间点进行评估：在儿科重症监护病房（PICU）住院 72 至 120 小时（P1）和 121 至 168 小时（P2），并计算两者之间的差异（delta mHLA-DR）。结果显示了住院期间的存活率、死亡率和继发感染率：47名儿童的中位数（IQR）年龄为24（10，96）个月，中位数（IQR）和病程均为3（3，5）天。63.8%的患儿的儿科逻辑器官功能障碍（PELOD）评分大于10分。18 名儿童死亡。与死亡儿童相比，P1 存活儿童的 mHLA-DR 水平中位数（ABC）明显更高（7409 对 2509，P = 0.004）。同样，P2 时存活儿童的 mHLA-DR 中位数水平（ABC）也高于过期组（14728 对 2085，P = 0.001）。72至120小时的mHLA-DR（P = 0.004）、121至168小时的mHLA-DR（P = 0.001）和delta mHLA-DR（P = 0.012）与死亡率显著相关，但与继发感染无关。在P1（r = -0.25，P = 0.46）、P2（r = -0.425，P = 0.018）和delta mHLA-DR（r = -0.27，P = 0.41）时，PELOD评分与mHLA-DR之间呈负相关。结论：在两个时间点，死亡儿童的 mHLA-DR 水平均显著低于存活儿童。

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来源期刊

Indian pediatrics 医学-小儿科

CiteScore

3.30

自引率

8.70%

发文量

344

审稿时长

3-8 weeks

期刊介绍： The general objective of Indian Pediatrics is "To promote the science and practice of Pediatrics." An important guiding principle has been the simultaneous need to inform, educate and entertain the target audience. The specific key objectives are: -To publish original, relevant, well researched peer reviewed articles on issues related to child health. -To provide continuing education to support informed clinical decisions and research. -To foster responsible and balanced debate on controversial issues that affect child health, including non-clinical areas such as medical education, ethics, law, environment and economics. -To achieve the highest level of ethical medical journalism and to produce a publication that is timely, credible and enjoyable to read.