Longitudinal monocyte Human leukocyte antigen-DR expression is a prognostic marker in critically ill patients with decompensated liver cirrhosis

Background: Critical illness in cirrhotic patients is associated with a poor prognosis and increased susceptibility to infections. Monocyte HLA‐DR expression is decreased in cirrhotic patients, but its prognostic value has not been investigated prospectively. Methods: Thirty‐eight critically ill patients with decompensated liver cirrhosis were included in this prospective study. On admission to the intensive care unit (ICU), inflammatory parameters (C‐reactive protein, procalcitonin and lipopolysaccharide‐binding protein), interleukin (IL)‐10, interferon (IFN)‐γ serum levels, tumour necrosis factor (TNF)‐αex vivo stimulation (whole blood assay) and HLA‐DR expression on monocytes (FACS analysis) were determined. Immune parameters were furthermore measured every third day until discharge from the ICU or death of the patients. Results: Intensive care unit mortality of the cirrhotic patients was 34.2%. During admission, TNF ex vivo, IFN‐γ and HLA‐DR expression were lower in non‐survivors (all P