tailieunhanh - Báo cáo y học: "Lack of recovery in monocyte human leukocyte antigen-DR expression is independently associated with the development of sepsis after major trauma"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care giúp cho các bạn có thêm kiến thức về ngành y học đề tài: Lack of recovery in monocyte human leukocyte antigen-DR expression is independently associated with the development of sepsis after major trauma. | Cheron et al. Critical Care 2010 14 R208 http content 14 6 R208 c CRITICAL CARE RESEARCH Open Access Lack of recovery in monocyte human leukocyte antigen-DR expression is independently associated with the development of sepsis after major trauma Aurélie Cheron1 Bernard Floccard1 Bernard Allaouchiche1 Caroline Guignant2 Frangoise Poitevin2 2 11 1 1 Christophe Malcus Jullien Crozon Alexandre Faure Christian Guillaume Guillaume Marcotte Alexandre Vulliez1 Olivier Monneuse3 Guillaume Monneret2 Abstract Introduction Major trauma is characterized by an overwhelming pro-inflammatory response and an accompanying anti-inflammatory response that lead to a state of immunosuppression as observed after septic shock. Diminished monocyte Human Leukocyte Antigen DR mHLA-DR is a reliable marker of monocyte dysfunction and immunosuppression. The main objective of this study was to determine the relation between mHLA-DR expression in severe trauma patients and the development of sepsis. Methods We conducted a prospective observational study over 23 months in a trauma intensive care unit at a university hospital. Patients with an Injury Severity Score ISS over 25 and age over 18 were included. mHLA-DR was assessed by flow cytometry protocol according to standardized protocol. Mann-Whitney U-test for continuous non-parametric variables independent paired t test for continuous parametric variables and chi-square test for categorical data were used. Results mHLA-DR was measured three times a week during the first 14 days. One hundred five consecutive severely injured patients were monitored ISS 38 17 SAPS II 37 16 . Thirty-seven patients 35 developed sepsis over the 14 days post-trauma. At days 1-2 mHLA-DR was diminished in the whole patient population with no difference with the development of sepsis. At days 3-4 a highly significant difference appeared between septic and non-septic patients. Non- septic patients showed an increase in mHLA-DR levels whereas septic patients .