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Chirurgia 2019 October;32(5):221-7

DOI: 10.23736/S0394-9508.18.04890-8


language: English

HLA-DR (cellular and soluble) and inflammatory serum markers in patients after trauma: can they predict outcome?

Mario SCHIETROMA 1, Beatrice PESSIA 1, Sara COLOZZI 1, Lucia ROMANO 1 , Vincenzo VICENTINI 1, Antonio GIULIANI 1, Carlo L. RECCHIA 2, Francesco CARLEI 1, Gianfranco AMICUCCI 1

1 Department of Surgery, San Salvatore Hospital, University of L’Aquila, L’Aquila, Italy; 2 Sora Hospital, Frosinone, Italy

BACKGROUND: Infectious complications remain a serious problem in patients after trauma. HLA-DR molecules have a central role in the activation of specific immune response to infection, and inflammatory mediators has been implicated in the pathogenesis of organ dysfunction. To asses whether HLA-DR and inflammatory markers predict the development of sepsis after trauma, a prospective study was performed in 95 injuried patients.
METHODS: The patients were categorized into three groups: with minor injury (Injury Severity Score: ISS<16) (group 1, n=17), severely injured patients (ISS>16) without sepsis (group 2, n=53), and severely injured patients (ISS>16) with sepsis (group 3, n=25). We monitored cellular and soluble HLA-DR plasma levels, interleukin-1β (IL-1β), interleukin 6 (Il-6), C-reactive Protein (CRP) and neutrophil elastase in the patients immediately after trauma and serially during the subsequent days.
RESULTS: The septic patients had significantly lower soluble HLA-DR plasma levels and lower cellular HLA-DR. A statistically significant increase of plasma elastase was recorded in patients with sepsis. IL-1β, IL-6 and CRP serum levels were significantly higher in group 3 and 2 if compared to group 1 on day 3, but there was not a significant difference between patients with sepsis and without sepsis.
CONCLUSIONS: After a severe injury, low levels of cellular and soluble HLA-DR was associated with development of sepsis. Elastase concentration increases in patients with sepsis. The concentrations of IL-1β, IL-6 and CRP increase in proportion to trauma, but not allows to distinguish infection from inflammation.

KEY WORDS: HLA-DR Antigens; Immune system; Sepsis

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