Monocyte activation during the first days in the ICU and survival in a heterogeneous group of patients requiring long-term intensive care

Overview

Objective:
To establish the predictive value of monocyte activation during the initial ICU days on the ICU survival of patients requiring long-term intensive care.

Design:
Prospective, clinical study.

Setting:
Department Anaesthesia and Intensive Care, St. Anna University Hospital, Brno, Czech Republic.

Material and methods:
The immune profile was taken in patients estimated to stay in the ICU > 3 days in 5- -day intervals. In this paper we report on activation of monocytes (Dr locus expression i.e. CD14+HLA-DR+) determined by flow-cytometry during the first 5 days of ICU stay.We study the relation of CD14+HLA-DR+ to ICU survival, type of admission (surgical, medical, trauma, CPR) and APACHE II.

Results:
147 patients were studied [M/F 106/41; mean age 63 (54; 73) years]. 123 survived their ICU stay (S) and 24 died (NS). APACHE II on admission was 27 (20; 32). On day1 the CD14+HLA-DR+ was not different in S and NS [62% (45; 76) and 62.5% (42; 82) respectively; p = 0.92] and its trend from day 1 to day 5 did not differ either [delta CD14+HLA-DR+ 18%(5; 32) and 5% (-23; 35)%, respectively; p = 0.19]. Surgical patients had significantly lower CD14+HLA-DR+ on admission compared to medical and CPR patients (p < 0.002 and p < 0.0002 respectively). No correlation was found between CD14+HLA-DR+ and APACHE II on admission (R = 0.015, p = 0.84).

Conclusion:
Monocyte activation (CD14+HLA-DR+) on admission to ICU and its trend until ICU day 5 do not predict ICU mortality in the heterogeneous population of long-term ICU patients.

Key words:
intensive – immunoparalysis – monocytes – APACHE II - outcome