Predicting the Outcomes of Subjects With Severe Community-Acquired Pneumonia Using Monocyte Human Leukocyte Antigen-DR.
BACKGROUND: The objective was to study the level of monocyte-human leukocyte antigen-DR (mHLA-DR), an immune function-related biomarker, at 24 h after admission, to predict the outcomes of subjects with severe pneumonia. METHODS: Subjects with severe community-acquired pneumonia (n = 102) were inclu...
| Publicado en: | Respiratory Care Vol. 60; no. 11; pp. 1635 - 1643 |
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| Autores principales: | , , , , , , , |
| Formato: | research tables/charts Journal Article |
| Publicado: |
Mary Ann Liebert, Inc.
Nov2015
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=110709067&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 110709067 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 00201324 4GG jtl: Respiratory Care issn: 00201324 maglogo: N pubinfo: dt: Nov2015 vid: 60 iid: 11 pid: 1365 pub: Mary Ann Liebert, Inc. place: New Rochelle, New York artinfo: ui: 110709067 110709067 110709067 10.4187/respcare.03953 NLM26264418 110709067 ppf: 1635 ppct: 8 formats: fmt: @attributes: type: P tig: atl: Predicting the Outcomes of Subjects With Severe Community-Acquired Pneumonia Using Monocyte Human Leukocyte Antigen-DR. aug: au: Yugang Zhuang Wenjie Li Huiqi Wang Hu Peng Yanqing Chen Xiangyu Zhang Yuanzhuo Chen Chengjin Gao affil: Emergency Department, Shanghai Tenth People's Hospital, Tongji University, School of Medicine, Shanghai, China sug: subj: Community-Acquired Pneumonia Biological Markers Outcomes (Health Care) HLA Antigens APACHE (Acute Physiology and Chronic Health Evaluation) Clinical Assessment Tools P-Value Confidence Intervals Flow Cytometry Human Survival Analysis Logistic Regression Kaplan-Meier Estimator Log-Rank Test Prospective Studies Intensive Care Units Blood Chemical Analysis Chi Square Test T-Tests Odds Ratio Shock, Septic Sensitivity and Specificity Respiration, Artificial Bacteremia Comorbidity Male Female Adult Middle Age Aged Aged, 80 and Over Youden's J Statistic Immune System Physiopathology Adult: 19-44 years Middle Aged: 45-64 years Aged: 65+ years Aged, 80 & over Male Female ab: BACKGROUND: The objective was to study the level of monocyte-human leukocyte antigen-DR (mHLA-DR), an immune function-related biomarker, at 24 h after admission, to predict the outcomes of subjects with severe pneumonia. METHODS: Subjects with severe community-acquired pneumonia (n = 102) were included in the study. Blood samples were collected from each subject 24 h after admission. Data regarding age, sex, ..., comorbidities, occurrence of altered mental status, bacteremia, septic shock, Acute Physiology and Chronic Health Evaluation (APACHE) II score, and Sequential Organ Failure Assessment (SOFA) score within the first 24 h; the highest temperature within 24 h after admission; mechanical ventilation usage; timing of antibiotic therapy; ICU stay; and 28-d survival were collected. Expression of mHLA-DR was measured by flow cytometry. RESULTS: APACHE II score and SOFA score were significantly higher (P < .001), whereas the mHLA-DR expression was significantly lower (P < .001) in the non-survivors than in the survivors. The outcomes at day 28 after admission were significantly associated with the APACHE II score (P = .002, odds ratio [OR] = 1.27, 95% Cl 1.10-1.48), the SOFA score (P = .003, OR = 1.52, 95% Cl 1.15-2.00), and mHLA-DR level (P = .01, OR = 0.91, 95% Cl 0.85-0.98), as shown by logistic regression. The area under the receiver operating characteristic curve was 0.877 (95% Cl 0.81-0.94, P < .001), 0.862 (95% Cl 0.79-0.93, P < .001), and 0.781 (95% Cl 0.69-0.87, P < .001) for APACHE II score, SOFA score, and the mHLA-DR expression, respectively. The optimal threshold for mHLA-DR level was 27.2%. Kaplan-Meier survival analysis showed that subjects with mHLA-DR > 27.2% had significantly better outcomes compared with < 27.2% level (P < .001, log rank test, hazard ratio = 0.963, 95% Cl 0.94-0.99). CONCLUSIONS: mHLA-DR may be a reliable biomarker that can predict the outcomes of patients with severe community-acquired pneumonia, and 27.2% may be the cut-off value to predict the outcomes. pubtype: Academic Journal doctype: research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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