ArticleIntensive care medicine2011
Severity of the compensatory anti-inflammatory response determined by monocyte HLA-DR expression may assist outcome prediction in cirrhosis.
Article in Intensive care medicine, 2011. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 46 papers.
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Who cites it
46 citing papers in PubMed, 74 citations in OpenAlex.
- Progressive Decline in Interferon-γ Release is Associated with Cirrhosis Progression and Severity: A Prospective Preliminary Report.Annals of laboratory medicine · 2026Article
- Critical illness expands a transcriptionally distinct hypometabolic CD8bioRxiv : the preprint server for biology · 2026Article
- Acute-on-chronic liver failure and immune dysregulation: Systemic inflammation and immunoparesis paradox.Hepatology communications · 2026Review
- Dysfunctional macrophages along the gut-liver axis: a driver of infection in cirrhosis.Frontiers in immunology · 2026Review
- Prospective Analysis of Perioperative Stress Response in Living Donor Liver Transplantation for Hepatitis B-Related Liver Disease.Journal of clinical medicine · 2025Article
- Association between the (neutrophil + monocyte)/albumin ratio and all-cause mortality in sepsis patients: a retrospective cohort study and predictive model establishment according to machine learning.BMC infectious diseases · 2025Article
- Mechanisms of immunity in acutely decompensated cirrhosis and acute-on-chronic liver failure.Liver international : official journal of the International Association for the Study of the Liver · 2025Review
- The immunosuppressive mechanisms induced by sepsis and the corresponding treatment strategies.Frontiers in immunology · 2025Review
- Metabolic Dysregulation and Metabolite Imbalances in Acute-on-chronic Liver Failure: Impact on Immune Status.Journal of clinical and translational hepatology · 2024Review
- Review
- Prognostic Value of Platelet-to-Monocyte Ratio for Mortality in HBV-Related Acute-on-Chronic Liver Failure.International journal of general medicine · 2024Article
- The role of trained immunity in sepsis.Frontiers in immunology · 2024Review
- Comparative analysis of monocyte-derived dendritic cell phenotype and T cell stimulatory function in patients with acute-on-chronic liver failure with different clinical parameters.Frontiers in immunology · 2023Article
- Reduction of natural killer cells is associated with poor outcomes in patients with hepatitis B virus-related acute-on-chronic liver failure.Hepatology international · 2022Article
- Sepsis-induced immunosuppression: mechanisms, diagnosis and current treatment options.Military Medical Research · 2022Review
- Liver cirrhosis and immune dysfunction.International immunology · 2022Review
- Suppressor CD4Gut · 2022Article
- Exaggerated inflammatory response to bacterial products in decompensated cirrhotic patients is orchestrated by interferons IL-6 and IL-8.American journal of physiology. Gastrointestinal and liver physiology · 2022Article
- Cirrhosis-associated immune dysfunction.Nature reviews. Gastroenterology & hepatology · 2022Review
- The Mechanisms of Systemic Inflammatory and Immunosuppressive Acute-on-Chronic Liver Failure and Application Prospect of Single-Cell Sequencing.Journal of immunology research · 2022Review
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Authors and funding
8 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeTo investigate variations in expression of the monocyte antigen presentation molecule HLA-DR in cirrhosis.
methodsHLA-DR expression was measured by flow cytometry in 100 patients within 48 h of admission and repeated a week later in 21 patients admitted to ICU. IL-10, TNF-α and IFN-γ secretion in response to lipopolysaccharide and recall antigens were measured by enzyme-linked immunosorbent spot (ELISPOT) assay in 12 patients (7 with clinical immunoparesis, 5 stable).
resultsHLA-DR level was 71% in stable patients, 53% with single organ dysfunction and 34% with multiple organ failure (p < 0.02). Within these groups, no significant differences in admission HLA-DR were seen between survivors and non-survivors. HLA-DR expression less than 40% predicted 90-day mortality with a specificity of 80% and sensitivity of 59% [area under the receiver operator curve (AUROC) 0.76]. HLA-DR less than 40% was an independent predictor of prognosis in multivariate analysis with a relative risk of 2.35 (p = 0.04), although sequential organ failure assessment score (SOFA) score displaced HLA-DR when included. In those admitted to intensive care failure to increase HLA-DR expression was predictive of death within 30 days (risk ratio 6.9, p = 0.007). Follow-up values predicted outcome with similar accuracy to acute physiology and chronic health evaluation II (APACHE II)/SOFA scores (AUROC 0.88). Response to endotoxin and recall antigen was characterised by an anti-inflammatory cytokine secretion profile, and was associated with impairment in recall antigen presentation capacity.
conclusionsHLA-DR expression less than 40% and a failure of recovery predict poor outcome in decompensated cirrhosis, but overall prognostic power remains inferior to conventional markers. Ex vivo experiments demonstrate reduced Th1 response to antigenic stimulation and an exaggerated counter-inflammatory cytokine secretion profile.
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