Monocytic Deactivation and Production of Tumour Necrosis Factor-α ex vivo: Prognostic Parameters
in Patients of ICU
Průcha M.1, Herold I.2, Zazula R.3, Dubská L.1, Kavka B.4
1Oddělení klinické biochemie, hematologie a imunologie, Nemocnice Na Homolce, Praha,přednosta prof.MUDr. J. Hyánek, DrSc.2Anesteziologicko-resuscitační oddělení, Klaudiánova nemocnice, Mladá Boleslav, primář MUDr. I. Herold, CSc.3Anesteziologicko-resuscitační oddělení, Fakultní Thomayerova nemocnice, Praha, primář MUDr. R. Zazula, PhD.4Anesteziologicko-resuscitační oddělení, Nemocnice Na Homolce, Praha, primář MUDr. M. Ročeň |
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Summary:
Objective: Dysbalance in immune system play an important role in pathogenesis of sepsis and systemic inflammatory
response syndrome (SIRS). Lowered expression of HLA-DR on monocytes coupled with decreased production of tumor
necrosis factor-α ex vivo after stimulation with lipopolysaccharide are characteristic features of immunoparalysis.Thestudy
aimed to determine importance and feasibility of their evaluation in patients with SIRS, sepsis and septic shock.
Design: Retrospective, cohort study.
Setting: Multidisciplinary intensive care unit.
Material and methods: 67 patients meeting the criteria for diagnosis of systemic inflammatory response syndrome (SIRS),
sepsis and septic shock according to the Consens Conference in 1991, admitted to the intensive care units were examined.
For determination of HLA-DR expression on monocytes flow cytometry was used and production of TNF-α ex vivo from
whole blood after lipopolysaccharide stimulation was evaluated by chemiluminiscence method utilising Vollblutstimulation
Kit (Millenia).
Results: Expression of HLA-DR on monocytes and TNF-α production were significantly decreased in patients with SIRS,
sepsis and septic shock compared to the control group (P < 0.001) and correlated significantly with diagnosis (Spearman´s
correlation coefficient r = -0.38, resp. r = -0.40, P < 0.0001). We found significant differences of both parameters between
subgroups of patients with SIRS and sepsis or SIRS and septic shock.
The values of expression of HLA-DR correlated significantly with values of TNF-α in patients with SIRS and sepsis (P =
0.0004, resp. P = 0.0003).
Last measured values of HLA-DR expression on monocytes and production of TNF-α were significantly lower in non-survivals
compared to survived (P < 0.001, resp. P < 0.05).
Conclusion:HLA-DR expression on monocytes and production of TNF-α ex vivo decrease in early phase of SIRS and sepsis.
Long lasting duration of their lower values is associated with unfavourable clinical outcome.
Key words:
HLA-DR – monocytes – immunoparalysis – sepsis – systemic inflammatory response syndrome – tumour
necrosis factor-α
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