{'fraction_non_alphanumeric': 0.04186289900575615, 'fraction_numerical': 0.013605442176870748, 'mean_word_length': 5.1877022653721685, 'pattern_counts': {'":': 0, '<': 1, '<?xml version=': 0, '>': 3, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
Monocytic HLA‐DR expression in intensive care patients: Interest for prognosis and secondary infection prediction *

Objectives: To test early measurement of human leukocyte antigen‐DR expression on circulating monocytes (mHLA‐DR) as prognostic marker, and the trend of mHLA‐DR recovery for the prediction of late secondary infection risk in a large intensive care unit population. Design: Prospective, observational study over 16 mos. Setting: Intensive care unit in a tertiary teaching hospital. Inclusion criteria: Simplified Acute Physiology Score II >15, age >18 yrs. Measurements and Main Results: The mHLA‐DR was measured by flow cytometry within the first 3 days and twice a week until discharge. We used a logistic regression model for outcome prediction, and a competing risk approach to test the relationship between mHLA‐DR recovery (log (mHLA‐DR) slope) and incidence of secondary infection. A total of 283 consecutive patients suffering from various pathologies were monitored (Simplified Acute Physiology Score II = 39, Sepsis‐related Organ Failure Assessment of 5 on day 0). Early mHLA‐DR was decreased in the whole population, however, more deeply in sepsis (p < .0001). Low mHLA‐DR was associated with mortality in the whole population (p = .003), as in subgroups (nonseptic, neurologic, and septic), but not when adjusted on Simplified Acute Physiology Score II. In patients with a length of stay of >7 days (n = 70), the lower the slope of mHLA‐DR recovery, the higher the incidence of the first secondary infection (adjusted on early mHLA‐DR, p = .04). Conclusions: For a given severity, mHLA‐DR proved not to a predictive marker of outcome, but a weak trend of mHLA‐DR recovery was associated with an increased risk of secondary infection. Monitoring immune functions through mHLA‐DR in intensive care unit patients therefore could be useful to identify a high risk of secondary infection.