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Comparative Study
. 2006;10(4):R119.
doi: 10.1186/cc5017.

HLA-DR expression on monocytes and systemic inflammation in patients with ruptured abdominal aortic aneurysms

Jan Willem W Haveman  1 , Aad P van den Berg, Eric L G Verhoeven, Maarten W N Nijsten, Jan J A M van den Dungen, Hauw T The, Jan H Zwaveling
Affiliations
Comparative Study

HLA-DR expression on monocytes and systemic inflammation in patients with ruptured abdominal aortic aneurysms

Jan Willem W Haveman et al. Crit Care. 2006.

Abstract

Introduction: Mortality from ruptured abdominal aortic aneurysms (RAAA) remains high. Severe systemic inflammation, leading to multi-organ failure, often occurs in these patients. In this study we describe the level of HLA-DR expression in a consecutive group of patients following surgery for RAAA and compare results between survivors and non-survivors. A similar comparison is made for IL-6, IL-10 levels and SOFA-scores.

Methods: This is a prospective observational study. Patients with RAAA were prospectively analyzed. Blood samples were collected on day 1, 3, 5, 7, 10 and 14. The fraction of CD-14 positive monocytes expressing HLA-DR was measured by flow-cytometry. Interleukin-6 and interleukin-10 levels were measured by ELISA.

Results: Thirty patients with a median age of 70 years were included. There were 27 (90%) men. Six patients died from multiple organ failure, all other patients survived. The Sequential Organ Failure Assessment (SOFA) scores were significantly higher in non-survivors on day 1 through 14. HLA-DR expression on monocytes was significantly lower on day 3, 5, 7, 10 and 14 in non-survivors. Interleukin-6 and IL-10 levels were significantly higher in non-survivors on day 1 and day 1 and 3 respectively.

Conclusions: HLA-DR expression on monocytes was decreased, especially in non-survivors. All patients with RAAA displayed a severe inflammatory and anti-inflammatory response with an increased production of IL-6 and IL-10. Poor outcome is associated with high levels of IL-6 and IL-10 and a high SOFA score in the first three days after surgery, while low levels of HLA-DR expression are observed from day three after RAAA repair.

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Figures

Figure 1
Figure 1
Sequential Organ Failure Assessment (SOFA) score after surgery for ruptured abdominal aortic aneurysm patients. The SOFA score was significantly (as indicated by asterisks) higher in non-survivors than survivors from day one post-surgery onwards.
Figure 2
Figure 2
IL-6 after ruptured abdominal aortic aneurysm repair. Levels of IL-6 (normal value < 20 pg/ml) were significantly higher on day one in non-survivors. *p < 0.05.
Figure 3
Figure 3
IL-10 after ruptured abdominal aortic aneurysm repair. Levels of IL-10 (normal value < 10 pg/ml) were significantly higher on days one and three in non-survivors. *p < 0.05.
Figure 4
Figure 4
HLA-DR expression on monocytes after ruptured abdominal aortic aneurysm repair. The expression of HLA-DR on monocytes (normal range 76% to 96%) of patients after RAAA is sharply and significantly decreased from day three post-surgery onwards. ap = 0.04; bp = 0.02; cp < 0.01.
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