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Minerva Anestesiologica 2000 October;66(10):757-63

Copyright © 2009 EDIZIONI MINERVA MEDICA

language: English

Assessment of immunological status in the critically ill

Payen D., Faivre V., Lukaszewicz A. C., Losser M. R.

From the Critical Care Division Department of Anesthesiology McGrill University - Montreal, Canada

The system­ic inflam­ma­to­ry ­response (­SIRS) ­results ­from var­i­ous ­types of inju­ries ­such as ­severe infec­tion, trau­ma, ische­mia-reper­fu­sion and ­major sur­gery includ­ing car­diac sur­gery ­with car­dio-pul­mo­nary ­bypass. This ­response ­involves ­immune ­cell acti­va­tion and a com­plex net­work of pro­in­flam­ma­to­ry cyto­kines, ­which may ­induce mul­ti­ple ­organ fail­ure ­when uncon­trolled. The mono­cyte ­plsys a cen­tral ­role in the ­response to infec­tion ­with the ­release of TNF-α, IL-1β, and IL-12. In addi­tion, mono­cy­tes ­present anti­gens to T lym­pho­cytes. An opti­mal anti­gen pres­en­ta­tion ­requires the expres­sion of MHC ­class II HLA-DR on mono­cy­tes sur­face and of cos­ti­mu­la­to­ry mole­cules ­such as CD54 on mono­cy­tes and LFA-1 on lym­pho­cytes. It has ­become increas­ing­ly appar­ent ­that the pro-inflam­ma­to­ry ­response is bal­anced by con­com­i­tant ­anti-inflam­ma­to­ry mech­a­nisms ­that ­results in mono­cyte deac­ti­va­tion, char­ac­ter­ized by a ­decrease in HLA-DR expres­sion and the ­release of ­anti-inflam­ma­to­ry cyto­kines ­such as IL-10. This coun­ter­reg­u­la­to­ry ­response, if pro­longed or pre­dom­i­nat, may pre­dis­pose the ­patient to a high­er ­risk of infec­tion. Further stud­ies ­need to be con­duct­ed to pre­cise: i) the inten­sity of depres­sion of the sur­face mol­o­cule expres­sion assess­ing mono­cyte func­tion, ­such as HLA DR and CD54; ii) the lev­el of IL-10 and IL-12 ­release in ­patients ­with ­severe sep­sis; iii) the immu­no-mod­ulat­ing ­effects of fre­quent­ly ­used treat­ments in ­these ­patients ­with ­severe sep­sis and in sur­gi­cal ­patients; iv) the ­time ­course of recov­ery; v) if the monit­or­ing of HLA-DR, CD54, IL-10 and IL-12 ­will bet­ter pre­dict the clin­i­cal out­come ­than clin­i­cal param­e­ters.