Coincidence of pro- and anti-inflammatory responses in the early phase of severe sepsis: Longitudinal study of mononuclear histocompatibility leukocyte antigen-DR expression, procalcitonin, C-reactive protein, and changes in T-cell subsets in septic and postoperative patients
OBJECTIVETo determine the time course of histocompatibility leukocyte antigen (HLA)-DR expression in peripheral blood mononuclear cells and their relationship to markers of inflammation, organ function, and outcome during severe sepsis. DESIGNProspective, longitudinal study. SETTINGUniversity hospit...
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| Veröffentlicht in: | Critical care medicine 2002-05, Vol.30 (5), p.1015-1023 |
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| creator | Tschaikowsky, Klaus Hedwig-Geissing, Monika Schiele, Albert Bremer, Frank Schywalsky, Michael Schüttler, Jürgen |
| description | OBJECTIVETo determine the time course of histocompatibility leukocyte antigen (HLA)-DR expression in peripheral blood mononuclear cells and their relationship to markers of inflammation, organ function, and outcome during severe sepsis.
DESIGNProspective, longitudinal study.
SETTINGUniversity hospital intensive care unit.
PATIENTSTwenty-three postoperative patients with severe sepsis and 26 patients with uneventful postoperative course as well as 24 healthy, age-matched subjects.
INTERVENTIONSSerum procalcitonin was determined by using an immunochemiluminescence assay, and C-reactive protein and leukocyte antigens were determined by using flow cytometry over 14 days in parallel with clinical data collection.
MEASUREMENTS AND MAIN RESULTSDespite a relative lymphopenia, absolute lymphocyte counts and CD4+/CD8+ T-cell ratio in septic patients were significantly elevated above normal. Particularly, CD4+ and CD8+ T-cell counts in nonsurvivors of sepsis were approximately twice as high as those of survivors. Significantly decreased monocytic HLA-DR expression was observed in both survivors and nonsurvivors at the onset of severe sepsis. Percentages of HLA-DR+ lymphocytes, however, were significantly increased during sepsis, especially in nonsurvivors. Whereas survivors of sepsis showed a continuous recovery of monocytic HLA-DR expression to ≥70% within 10 days, nonsurvivors were characterized by a second decrease in monocytic HLA-DR expression after day 7 or a permanent suppression ( |
| doi_str_mv | 10.1097/00003246-200205000-00010 |
| format | Article |
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DESIGNProspective, longitudinal study.
SETTINGUniversity hospital intensive care unit.
PATIENTSTwenty-three postoperative patients with severe sepsis and 26 patients with uneventful postoperative course as well as 24 healthy, age-matched subjects.
INTERVENTIONSSerum procalcitonin was determined by using an immunochemiluminescence assay, and C-reactive protein and leukocyte antigens were determined by using flow cytometry over 14 days in parallel with clinical data collection.
MEASUREMENTS AND MAIN RESULTSDespite a relative lymphopenia, absolute lymphocyte counts and CD4+/CD8+ T-cell ratio in septic patients were significantly elevated above normal. Particularly, CD4+ and CD8+ T-cell counts in nonsurvivors of sepsis were approximately twice as high as those of survivors. Significantly decreased monocytic HLA-DR expression was observed in both survivors and nonsurvivors at the onset of severe sepsis. Percentages of HLA-DR+ lymphocytes, however, were significantly increased during sepsis, especially in nonsurvivors. Whereas survivors of sepsis showed a continuous recovery of monocytic HLA-DR expression to ≥70% within 10 days, nonsurvivors were characterized by a second decrease in monocytic HLA-DR expression after day 7 or a permanent suppression (<40%). Peak of systemic inflammatory reaction, documented by maximum serum concentrations of procalcitonin and C-reactive protein, coincided with the nadir of monocytic HLA-DR expression. Moreover, procalcitonin and C-reactive protein as well as scores on the Acute Physiology and Chronic Health Evaluation II and Sepsis Organ Failure Assessment were inversely correlated with the monocytic HLA-DR expression.
CONCLUSIONSDecreases in monocytic HLA-DR expression occurred simultaneously with signs of hyperinflammation as early as the onset of severe sepsis and usually developed in opposite directions than inflammatory markers and sepsis severity scores.</description><identifier>ISSN: 0090-3493</identifier><identifier>EISSN: 1530-0293</identifier><identifier>DOI: 10.1097/00003246-200205000-00010</identifier><identifier>PMID: 12006796</identifier><identifier>CODEN: CCMDC7</identifier><language>eng</language><publisher>Hagerstown, MD: by the Society of Critical Care Medicine and Lippincott Williams & Wilkins</publisher><subject>Aged ; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; Biological and medical sciences ; C-Reactive Protein - analysis ; Calcitonin - blood ; Calcitonin Gene-Related Peptide ; Emergency and intensive care: infection, septic shock ; Female ; Flow Cytometry ; HLA-DR Antigens - analysis ; Humans ; Inflammation - blood ; Inflammation - immunology ; Intensive care medicine ; Longitudinal Studies ; Male ; Medical sciences ; Monocytes - immunology ; Postoperative Period ; Prospective Studies ; Protein Precursors - blood ; Sepsis - blood ; Sepsis - immunology ; T-Lymphocyte Subsets</subject><ispartof>Critical care medicine, 2002-05, Vol.30 (5), p.1015-1023</ispartof><rights>2002 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins</rights><rights>2002 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4150-ab8258b38f13c6f84f51fcc8ed7069f47221cf9dfdbd054a71107de4c8a2992c3</citedby><cites>FETCH-LOGICAL-c4150-ab8258b38f13c6f84f51fcc8ed7069f47221cf9dfdbd054a71107de4c8a2992c3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=14170643$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/12006796$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Tschaikowsky, Klaus</creatorcontrib><creatorcontrib>Hedwig-Geissing, Monika</creatorcontrib><creatorcontrib>Schiele, Albert</creatorcontrib><creatorcontrib>Bremer, Frank</creatorcontrib><creatorcontrib>Schywalsky, Michael</creatorcontrib><creatorcontrib>Schüttler, Jürgen</creatorcontrib><title>Coincidence of pro- and anti-inflammatory responses in the early phase of severe sepsis: Longitudinal study of mononuclear histocompatibility leukocyte antigen-DR expression, procalcitonin, C-reactive protein, and changes in T-cell subsets in septic and postoperative patients</title><title>Critical care medicine</title><addtitle>Crit Care Med</addtitle><description>OBJECTIVETo determine the time course of histocompatibility leukocyte antigen (HLA)-DR expression in peripheral blood mononuclear cells and their relationship to markers of inflammation, organ function, and outcome during severe sepsis.
DESIGNProspective, longitudinal study.
SETTINGUniversity hospital intensive care unit.
PATIENTSTwenty-three postoperative patients with severe sepsis and 26 patients with uneventful postoperative course as well as 24 healthy, age-matched subjects.
INTERVENTIONSSerum procalcitonin was determined by using an immunochemiluminescence assay, and C-reactive protein and leukocyte antigens were determined by using flow cytometry over 14 days in parallel with clinical data collection.
MEASUREMENTS AND MAIN RESULTSDespite a relative lymphopenia, absolute lymphocyte counts and CD4+/CD8+ T-cell ratio in septic patients were significantly elevated above normal. Particularly, CD4+ and CD8+ T-cell counts in nonsurvivors of sepsis were approximately twice as high as those of survivors. Significantly decreased monocytic HLA-DR expression was observed in both survivors and nonsurvivors at the onset of severe sepsis. Percentages of HLA-DR+ lymphocytes, however, were significantly increased during sepsis, especially in nonsurvivors. Whereas survivors of sepsis showed a continuous recovery of monocytic HLA-DR expression to ≥70% within 10 days, nonsurvivors were characterized by a second decrease in monocytic HLA-DR expression after day 7 or a permanent suppression (<40%). Peak of systemic inflammatory reaction, documented by maximum serum concentrations of procalcitonin and C-reactive protein, coincided with the nadir of monocytic HLA-DR expression. Moreover, procalcitonin and C-reactive protein as well as scores on the Acute Physiology and Chronic Health Evaluation II and Sepsis Organ Failure Assessment were inversely correlated with the monocytic HLA-DR expression.
CONCLUSIONSDecreases in monocytic HLA-DR expression occurred simultaneously with signs of hyperinflammation as early as the onset of severe sepsis and usually developed in opposite directions than inflammatory markers and sepsis severity scores.</description><subject>Aged</subject><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</subject><subject>Biological and medical sciences</subject><subject>C-Reactive Protein - analysis</subject><subject>Calcitonin - blood</subject><subject>Calcitonin Gene-Related Peptide</subject><subject>Emergency and intensive care: infection, septic shock</subject><subject>Female</subject><subject>Flow Cytometry</subject><subject>HLA-DR Antigens - analysis</subject><subject>Humans</subject><subject>Inflammation - blood</subject><subject>Inflammation - immunology</subject><subject>Intensive care medicine</subject><subject>Longitudinal Studies</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Monocytes - immunology</subject><subject>Postoperative Period</subject><subject>Prospective Studies</subject><subject>Protein Precursors - blood</subject><subject>Sepsis - blood</subject><subject>Sepsis - immunology</subject><subject>T-Lymphocyte Subsets</subject><issn>0090-3493</issn><issn>1530-0293</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2002</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1ks1v1DAQxQMC0aVw44x8gRMBO3G-ekPLp7QSEirnyHHGG1PHDrbTkv-eSXahJyJZ43F-z_MSvSQhjL5ltKneUXzyjJdpRmlGC-xSXIw-THasyLHJmvxRsqO0oWnOm_wieRrCTyR4UeVPkguGurJqyt2DF3unrdQ9WAnEKTJ5lxJhe1xRp9oqI8ZRROcX4iFMzgYIRFsSByAgvFnINIiwSQPcggcsU9DhihycPeo499oKQwJulhUanXV2lga1ZNAhOunGSUTdaaPjQgzMN04uEbb5R7Dph-8Efk84O2hn36z-pDBSR2c1tvvUg5BR38L6JsJ6trqXg7DHk9PrVIJBB3MXIG4n6DBquXGTQwsTeHG6AgvYGJ4lj5UwAZ6f62Xy49PH6_2X9PDt89f9-0MqOStoKro6K-ourxXLZalqrgqmpKyhr2jZKF5lGZOq6VXf9bTgomKMVj1wWYusaTKZXyavT_ei918zhNiOOqxuhQU3h7ZiZVXzrEKwPoHSuxA8qHbyehR-aRlt10S0fxPR_ktEuyUCpS_PM-ZuhP5eeI4AAq_OgAj4a5UXmIdwz3GGX8Nz5PiJu3Mmgg83Zr4D3w4gTBza_yUy_wNzNdVl</recordid><startdate>200205</startdate><enddate>200205</enddate><creator>Tschaikowsky, Klaus</creator><creator>Hedwig-Geissing, Monika</creator><creator>Schiele, Albert</creator><creator>Bremer, Frank</creator><creator>Schywalsky, Michael</creator><creator>Schüttler, Jürgen</creator><general>by the Society of Critical Care Medicine and Lippincott Williams & Wilkins</general><general>Lippincott</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>200205</creationdate><title>Coincidence of pro- and anti-inflammatory responses in the early phase of severe sepsis: Longitudinal study of mononuclear histocompatibility leukocyte antigen-DR expression, procalcitonin, C-reactive protein, and changes in T-cell subsets in septic and postoperative patients</title><author>Tschaikowsky, Klaus ; Hedwig-Geissing, Monika ; Schiele, Albert ; Bremer, Frank ; Schywalsky, Michael ; Schüttler, Jürgen</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4150-ab8258b38f13c6f84f51fcc8ed7069f47221cf9dfdbd054a71107de4c8a2992c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2002</creationdate><topic>Aged</topic><topic>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</topic><topic>Biological and medical sciences</topic><topic>C-Reactive Protein - analysis</topic><topic>Calcitonin - blood</topic><topic>Calcitonin Gene-Related Peptide</topic><topic>Emergency and intensive care: infection, septic shock</topic><topic>Female</topic><topic>Flow Cytometry</topic><topic>HLA-DR Antigens - analysis</topic><topic>Humans</topic><topic>Inflammation - blood</topic><topic>Inflammation - immunology</topic><topic>Intensive care medicine</topic><topic>Longitudinal Studies</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Monocytes - immunology</topic><topic>Postoperative Period</topic><topic>Prospective Studies</topic><topic>Protein Precursors - blood</topic><topic>Sepsis - blood</topic><topic>Sepsis - immunology</topic><topic>T-Lymphocyte Subsets</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Tschaikowsky, Klaus</creatorcontrib><creatorcontrib>Hedwig-Geissing, Monika</creatorcontrib><creatorcontrib>Schiele, Albert</creatorcontrib><creatorcontrib>Bremer, Frank</creatorcontrib><creatorcontrib>Schywalsky, Michael</creatorcontrib><creatorcontrib>Schüttler, Jürgen</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Critical care medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Tschaikowsky, Klaus</au><au>Hedwig-Geissing, Monika</au><au>Schiele, Albert</au><au>Bremer, Frank</au><au>Schywalsky, Michael</au><au>Schüttler, Jürgen</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Coincidence of pro- and anti-inflammatory responses in the early phase of severe sepsis: Longitudinal study of mononuclear histocompatibility leukocyte antigen-DR expression, procalcitonin, C-reactive protein, and changes in T-cell subsets in septic and postoperative patients</atitle><jtitle>Critical care medicine</jtitle><addtitle>Crit Care Med</addtitle><date>2002-05</date><risdate>2002</risdate><volume>30</volume><issue>5</issue><spage>1015</spage><epage>1023</epage><pages>1015-1023</pages><issn>0090-3493</issn><eissn>1530-0293</eissn><coden>CCMDC7</coden><abstract>OBJECTIVETo determine the time course of histocompatibility leukocyte antigen (HLA)-DR expression in peripheral blood mononuclear cells and their relationship to markers of inflammation, organ function, and outcome during severe sepsis.
DESIGNProspective, longitudinal study.
SETTINGUniversity hospital intensive care unit.
PATIENTSTwenty-three postoperative patients with severe sepsis and 26 patients with uneventful postoperative course as well as 24 healthy, age-matched subjects.
INTERVENTIONSSerum procalcitonin was determined by using an immunochemiluminescence assay, and C-reactive protein and leukocyte antigens were determined by using flow cytometry over 14 days in parallel with clinical data collection.
MEASUREMENTS AND MAIN RESULTSDespite a relative lymphopenia, absolute lymphocyte counts and CD4+/CD8+ T-cell ratio in septic patients were significantly elevated above normal. Particularly, CD4+ and CD8+ T-cell counts in nonsurvivors of sepsis were approximately twice as high as those of survivors. Significantly decreased monocytic HLA-DR expression was observed in both survivors and nonsurvivors at the onset of severe sepsis. Percentages of HLA-DR+ lymphocytes, however, were significantly increased during sepsis, especially in nonsurvivors. Whereas survivors of sepsis showed a continuous recovery of monocytic HLA-DR expression to ≥70% within 10 days, nonsurvivors were characterized by a second decrease in monocytic HLA-DR expression after day 7 or a permanent suppression (<40%). Peak of systemic inflammatory reaction, documented by maximum serum concentrations of procalcitonin and C-reactive protein, coincided with the nadir of monocytic HLA-DR expression. Moreover, procalcitonin and C-reactive protein as well as scores on the Acute Physiology and Chronic Health Evaluation II and Sepsis Organ Failure Assessment were inversely correlated with the monocytic HLA-DR expression.
CONCLUSIONSDecreases in monocytic HLA-DR expression occurred simultaneously with signs of hyperinflammation as early as the onset of severe sepsis and usually developed in opposite directions than inflammatory markers and sepsis severity scores.</abstract><cop>Hagerstown, MD</cop><pub>by the Society of Critical Care Medicine and Lippincott Williams & Wilkins</pub><pmid>12006796</pmid><doi>10.1097/00003246-200205000-00010</doi><tpages>9</tpages></addata></record> |
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| ispartof | Critical care medicine, 2002-05, Vol.30 (5), p.1015-1023 |
| issn | 0090-3493 1530-0293 |
| language | eng |
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| source | MEDLINE; Journals@Ovid Complete |
| subjects | Aged Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Biological and medical sciences C-Reactive Protein - analysis Calcitonin - blood Calcitonin Gene-Related Peptide Emergency and intensive care: infection, septic shock Female Flow Cytometry HLA-DR Antigens - analysis Humans Inflammation - blood Inflammation - immunology Intensive care medicine Longitudinal Studies Male Medical sciences Monocytes - immunology Postoperative Period Prospective Studies Protein Precursors - blood Sepsis - blood Sepsis - immunology T-Lymphocyte Subsets |
| title | Coincidence of pro- and anti-inflammatory responses in the early phase of severe sepsis: Longitudinal study of mononuclear histocompatibility leukocyte antigen-DR expression, procalcitonin, C-reactive protein, and changes in T-cell subsets in septic and postoperative patients |
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