Could Monocyte Human Leukocyte Antigen-DR Expression help as a prognostic indicator of Sepsis

Abstract

Background:   Fever, capillary leakage, and organ failure are symptoms of the proinflammatory surge that characterizes the initial host immunological response to sepsis in children. On the other hand, innate and adaptive immune cells become hyporesponsive as a result of the concomitant anti-inflammatory response. Serious cases of this reaction, known as immunoparalysis, can lead to organ failure for an extended period of time, an increased likelihood of nosocomial infections, and even mortality in infants and adults with septic shock. Reductions in absolute cell counts, expression of human leukocyte antigen (HLA)-DR on circulating monocytes, and whole blood ex vivo stimulated cytokine production capacity are laboratory indicators of sepsis-induced immune suppression. Immunostimulatory treatments, such granulocyte macrophage colony-stimulating factor (GM-CSF), show potential in patients with sepsis-induced immunoparalysis, in contrast to anti-inflammatory medicines, which have generally failed to improve outcomes from both pediatric and adult sepsis. Improving outcomes for children with septic shock requires more research into immunoparalysis risk factors and the design and implementation of treatment trials targeting specific immunophenotypes to optimize innate and adaptive immune function. The association between low mHLA-DR expression and deleterious outcomes, deserves to be assessed and confirmed in multicenter studies.