ArticleIntensive care medicine2025
Monocyte HLA-DR expression in septic shock patients: insights from a 20-year real-world cohort of 1023 cases.
Article in Intensive care medicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 25 papers.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
25 citing papers in PubMed.
- Lymphopenia and elevated NLR identify patients with septic shock who may benefit from corticosteroids: a target trial emulation study.Intensive care medicine experimental · 2026Article
- Early Immune Phenotype-Guided Immunomodulatory Strategies and Intensive Care Outcomes in Septic Shock: A Single-Center Retrospective Cohort Study.Shock (Augusta, Ga.) · 2026Observational
- Early Identification of a Cytokine-Low Immune Phenotype in Suspected Sepsis Using a Point-of-Care Whole-Blood TNF-α Release Assay.Medical sciences (Basel, Switzerland) · 2026Article
- Characterization of IgG N-glycan patterns in COVID-19, sepsis and healthy subjects.Scientific reports · 2026Article
- Monitoring T-cell function in septic shock: one-year experience with a fully automated assay.Critical care (London, England) · 2026Observational
- Neutrophil-to-lymphocyte ratio as a practical alternative to mHLA-DR measurement in delayed sepsis-induced immunosuppression.Intensive care medicine · 2026Article
- Immunological impact of age and comorbidities: findings from the REALISM and SENIOR-HLA-DR cohorts.Aging clinical and experimental research · 2026Article
- Article
- Update on sepsis and septic shock: from bundles to precision medicine.Intensive care medicine · 2026Article
- Assessment of soluble PD-L1 in septic shock in relation to immunosuppressive phenotypes.Annals of intensive care · 2026Article
- Early biomarkers for predicting sepsis-induced shock: insights from inflammatory pathways and immune response.Frontiers in pharmacology · 2026Review
- Systematic review, meta-analysis, and meta-regression of the association of serial leukocyte counts in critically ill patients and mortality.Annals of intensive care · 2026Article
- Targeting VISTA for immunomodulation in sepsis: mechanisms and therapeutic potentials.Frontiers in immunology · 2026Review
- Peripheral immune phenotyping identifies an immunosuppressed sepsis endotype with potential relevance for immune stratification.Frontiers in immunology · 2026Article
- Comparative predictive value of nine inflammation-derived haematological indices for 28-day mortality in patients with sepsis: a multicentre retrospective cohort study.Frontiers in medicine · 2026Article
- Inflammation-driven immune reprogramming in sepsis: from cytokine storm to immunoparalysis.Frontiers in immunology · 2026Review
- Article
- Parallel single-cell host immune profiling and pathogen genomic characterization inFrontiers in cellular and infection microbiology · 2026Observational
- Point-of-care LPS-induced TNF-α release testing for early sepsis risk stratification in the emergency department.Frontiers in immunology · 2026Observational
- The inflammation-immunosuppression loop as a driver of immune dysfunction and secondary infections in severe COVID-19.Frontiers in immunology · 2026Review
Corrections and comments
- Erratum issued
Authors and funding
13 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeSeptic patients simultaneously experience hyperinflammation and immunosuppression, the latter driving ICU-acquired infections, prolonged stays in ICU, and increased mortality. As immunostimulant therapies enter clinical trials, effective stratification is critical to identify patients with the most profound immune dysfunction. Monocyte HLA-DR expression (mHLA-DR) has emerged as the most reliable and actionable biomarker of sepsis-induced immunosuppression.
methodsWe conducted a real-world, 20-year cohort study of 1023 septic shock patients, measuring mHLA-DR by standardized flow cytometry during the first week of ICU admission. Primary outcomes included day-28 and day-90 mortality, and ICU-acquired infections.
resultsLow mHLA-DR (< 8000 AB/C, a threshold already used in phase II trials) was significantly associated with increased mortality and ICU-acquired infections. This association held across static and dynamic measures, multivariate analyses, Kaplan-Meier survival curves, and trajectory clustering (K-means).
conclusionsThis large real-world study confirms that mHLA-DR is a robust enrichment biomarker for identifying the most immunosuppressed septic shock patients at higher risk of adverse outcomes. Importantly, time-course analysis suggests that early immune downregulation may represent a physiological adaptation, while delayed and persistent immunosuppression is associated with worse outcomes. Early single time-point measurements may fail to identify patients who are unlikely to develop delayed immunosuppression. Tracking mHLA-DR trajectories after the initial ICU days is essential for detecting persistent immune dysfunction and selecting patients in case of immunostimulant approaches.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.