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Assessment of Sepsis Index and HLA-DR Expression on Monocytes as Predictive Sepsis Biomarkers

B. Quirant Sanchez1,3*, E. Lucas1, O. Plans Galvan2, E. Argudo2, F. Armestar2, E. Martinez Caceres1,3*

Background: The reduction of mortality in patients with sepsis depends on the early identification and treatment of at risk patients. No specific biomarkers have been found yet to reliably identify these patients.

Methods: We evaluated the association between mHLA-DR expression and the sepsis index (NCD64/MHLADR ratio) with the development of sepsis in 59 patients with stroke and 18 with traumatic brain injury. Both biomarkers were tested in whole blood samples at baseline and 3 days, 6 days, 9 days, 12 days and 15 days later.

Results: Most patients (71%) developed sepsis (4.2 ± 1.3 days after admission). On day 3, those subsequently developing sepsis had lower levels of mHLA-DR+(81.7% ± 16.2% vs. 88.5% ± 12.1%, p<0.05) and a higher sepsis index (0.19 ± 0.19 vs. 0.08 ± 0.08, p<0.01) tan those not developing sepsis. The mHLA-DR ratio slowly recovered before day 6, while the sepsis index remained raised in septic patients up to day 9 (p<0.05).

Conclusion: Periodic monitoring of the mHLA-DR expression together CRP and sepsis index may help to identify patients in the ICU at increased risk to develop sepsis.