Predictive analysis for prognosis of CD14+ monocyte HLA-DR in geriatric trauma patients / 解放军医学杂志

ABSTRACT

Object To evaluate the prognostic roles of HLA-DR+/CD14+ expression rate in peripheral blood monocytes in geriatric trauma sepsis. Methods A retrospective study of clinical data was carried out. Clinical data of geriatric trauma patients (age≥60 years) admitted to intensive care unit (ICU) of Guangzhou General Hospital of Guangzhou Command from January 2011 to December 2015 were collected. The expressions of HLA-DR+/CD14+, procalcitonin (PCT) and C-reactive protein (CRP) were detected within 24 hours after admission. Spearman correlation analysis was adopted to analyze the correlation between the HLADR+/CD14+ and the length of ICU stay, and between the length of stay and APACHE II. Receiver operating characteristic (ROC) curve was used to evaluate the prognostic roles of HLA-DR+/CD14+ expression, PCT, CRP and APACHE II score. Results There were significant differences between survivors and nonsurvivors in APACHE II score (17.49 6.25 vs 27.38 8.68, P<0.05) and the expressions of HLA-DR+/CD14+ (59.80 18.02 vs 37.70 13.96, P<0.01). There were significant differences between sepsis and non-sepsis in APACHE II score (26.16 8.44 vs 17.90 7.04, P<0.01) and the expressions of HLA-DR+/CD14+ (38.61 14.48 vs 59.79 18.17, P<0.01), PCT (34.45 68.29 vs 4.25 8.26, P<0.01) and CRP (129.88 103.25 vs 76.04 73.48, P<0.011). There existed a negative relationship between the HLA-DR+/CD14+ and length of ICU stay (r=-0.304, P=0.008), and APACHE (r=-0.559, P=0.000). There was no significant relationship between the HLA-DR+/CD14+ and length of stay (r=0.188, P=0.106). By ROC for sepsis prognosis, the area under the curve (Mean SE) of HLA-DR+/CD14+ was 0.807 0.051 (95%CI 0.706-0.907, P=0.000), the AU-ROC (Mean SE) of PCT was 0.714 0.063 (95% CI 0.591-0.837, P=0.003). The best cut-off for HLA-DR+/CD14+ was 40%, with the sensitivity of 88.0% and specificity of 60.0%.The best cut-off for PCT was 1.01, with the sensitivity of 84.0% and specificity of 65.0%. By ROC curve analysis for prognosis, the AU-ROC (Mean SE) of HLA-DR+/CD14+ and APACHE II were 0.813 0.049 (95%CI 0.716-0.910, P=0.00) and 0.825 0.052 (95% CI 0.724-0.926, P=0.000), respectively. The best cut-off for HLA-DR+/CD14+ was 36.0%, with the sensitivity of 94.1% and specificity of 50.0%. The best cut-off for APACHE II was 20, with the sensitivity of 80.1% and specificity of 65.0%. Conclusion Low expression of HLA-DR+/CD14+ indicates hypoimmunity of geriatric trauma patients, and can play an significant role in predicting development of sepsis and poor prognosis.