ArticleCritical care (London, England)2020
Monocytic HLA-DR expression kinetics in septic shock patients with different pathogens, sites of infection and adverse outcomes.
Article in Critical care (London, England), 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 91 papers, 2 of them syntheses that pooled it.
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Who cites it
91 citing papers in PubMed, 2 syntheses or guidelines pooled it, 149 citations in OpenAlex.
- Prognostic differences in sepsis caused by gram-negative bacteria and gram-positive bacteria: a systematic review and meta-analysis.Critical care (London, England) · 2023Pooled it
- Epigenetic mechanisms of Immune remodeling in sepsis: targeting histone modification.Cell death & disease · 2023Pooled it
- Enteral citrulline supplementation versus placebo on SOFA score on day 7 in mechanically ventilated critically ill patients: the IMMUNOCITRE randomized clinical trial.Critical care (London, England) · 2023Trial
- Integrated host-microbe plasma metagenomics for sepsis diagnosis in a prospective cohort of critically ill adults.Nature microbiology · 2022Trial
- Monocyte Trajectories Endotypes Are Associated With Worsening in Septic Patients.Frontiers in immunology · 2021Trial
- FOLR3+neutrophils contribute to sepsis by exacerbating hyper-inflammation.Genes and immunity · 2026Article
- Blood biomarker trajectories in ICU-directed prediction models - A scoping review.The EPMA journal · 2026Review
- Validation of SOFA-2 score in sepsis and exploration of its extension with additional immune markers.Journal of intensive medicine · 2026Article
- EBV reactivation and immunoparalysis indicate a harmful immune endotype in sepsis.Critical care (London, England) · 2026Article
- Age-related differences and common pathways of lymphocyte subsets in sepsis: a comparative review of elderly and pediatric patients.Cell death & disease · 2026Review
- Combined effects of mesenchymal stromal cells and antibiotic therapy on Enterobacter ventilator-associated pneumonia in rabbits.Respiratory research · 2026Article
- Thirty years of mHLA-DR research in septic shock: lessons and caveats for clinical translation.Intensive care medicine · 2026Article
- Nano-Enabled Microfluidic Platforms for Functional Immunomonitoring in Pediatric Sepsis.International journal of nanomedicine · 2026Review
- Beyond antimicrobials: a host-directed precision pharmacotherapy framework for septic shock.Frontiers in medicine · 2026Article
- Host-response trajectories in necrotizing fasciitis: host-pathogen interactions, immune evasion, and immunoparalysis.Frontiers in cellular and infection microbiology · 2026Review
- Identification of distinct immune subtypes in sepsis through dual immunomarker trajectory.Annals of intensive care · 2026Article
- Preventing ventilator-associated pneumonia via the gut-lung axis: the Shenling Baizhu San hypothesis.Frontiers in medicine · 2026Article
- Traditional Chinese medicine in sepsis-associated PICS: potential immunometabolic mechanisms and translational perspectives.Frontiers in immunology · 2026Review
- Early biomarkers for predicting sepsis-induced shock: insights from inflammatory pathways and immune response.Frontiers in pharmacology · 2026Review
- The immunology of sepsis: translating new insights into clinical practice.Nature reviews. Nephrology · 2026Review
31 more citing papers are in PubMed but not listed here.
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Authors and funding
9 authors at 3 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundDecreased monocytic (m)HLA-DR expression is the most studied biomarker of sepsis-induced immunosuppression. To date, little is known about the relationship between sepsis characteristics, such as the site of infection, causative pathogen, or severity of disease, and mHLA-DR expression kinetics.
methodsWe evaluated mHLA-DR expression kinetics in 241 septic shock patients with different primary sites of infection and pathogens. Furthermore, we used unsupervised clustering analysis to identify mHLA-DR trajectories and evaluated their association with outcome parameters.
resultsNo differences in mHLA-DR expression kinetics were found between groups of patients with different sites of infection (abdominal vs. respiratory, p = 0.13; abdominal vs. urinary tract, p = 0.53) and between pathogen categories (Gram-positive vs. Gram-negative, p = 0.54; Gram-positive vs. negative cultures, p = 0.84). The mHLA-DR expression kinetics differed between survivors and non-survivors (p < 0.001), with an increase over time in survivors only. Furthermore, we identified three mHLA-DR trajectories ('early improvers', 'delayed or non-improvers' and 'decliners'). The probability for adverse outcome (secondary infection or death) was higher in the delayed or non-improvers and decliners vs. the early improvers (delayed or non-improvers log-rank p = 0.03, adjusted hazard ratio 2.0 [95% CI 1.0-4.0], p = 0.057 and decliners log-rank p = 0.01, adjusted hazard ratio 2.8 [95% CI 1.1-7.1], p = 0.03).
conclusionSites of primary infection or causative pathogens are not associated with mHLA-DR expression kinetics in septic shock patients. However, patients showing delayed or no improvement in or a declining mHLA-DR expression have a higher risk for adverse outcome compared with patients exhibiting a swift increase in mHLA-DR expression. Our study signifies that changes in mHLA-DR expression over time, and not absolute values or static measurements, are of clinical importance in septic shock patients.
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