Predictive analysis for prognosis of CD14+ monocyte HLA-DR in geriatric trauma patients

Objective 　To evaluate the prognostic roles of HLA-DR+/CD14+ expression rate in peripheral blood monocytes in geriatric trauma sepsis. Methods 　A retrospective study of clinical data was carried out. Clinical data of geriatric trauma patients (age≥60 years) admitted to intensive care unit (ICU) of Guangzhou General Hospital of Guangzhou Command from January 2011 to December 2015 were collected. The expressions of HLA-DR+/CD14+, procalcitonin (PCT) and C-reactive protein (CRP) were detected within 24 hours after admission. Spearman correlation analysis was adopted to analyze the correlation between the HLADR+/CD14+ and the length of ICU stay, and between the length of stay and APACHE Ⅱ. Receiver operating characteristic (ROC) curve was used to evaluate the prognostic roles of HLA-DR+/CD14+ expression, PCT, CRP and APACHE Ⅱscore. Results 　There were significant differences between survivors and nonsurvivors in APACHE Ⅱscore (17.49±6.25 vs 27.38±8.68, P<0.05) and the expressions of HLA-DR+/CD14+ (59.80±18.02 vs 37.70±13.96, P<0.01). There were significant differences between sepsis and non-sepsis in APACHEⅡscore (26.16±8.44 vs 17.90±7.04, P<0.01) and the expressions of HLA-DR+/CD14+ (38.61±14.48 vs 59.79±18.17, P<0.01), PCT (34.45±68.29 vs 4.25±8.26, P<0.01) and CRP (129.88±103.25 vs 76.04±73.48, P<0.011). There existed a negative relationship between the HLA-DR+/CD14+ and length of ICU stay (r=–0.304, P=0.008), and APACHE Ⅱ(r=–0.559, P=0.000). There was no significant relationship between the HLA-DR+/CD14+ and length of stay (r=0.188, P=0.106). By ROC for sepsis prognosis, the area under the curve (Mean±SE) of HLA-DR+/CD14+ was 0.807±0.051 (95%CI 0.706-0.907, P=0.000), the AU-ROC (Mean±SE) of PCT was 0.714±0.063 (95% CI：0.591-0.837, P=0.003). The best cut-off for HLA-DR+/ CD14+ was 40%, with the sensitivity of 88.0% and specificity of 60.0%.The best cut-off for PCT was 1.01, with the sensitivity of 84.0% and specificity of 65.0%. By ROC curve analysis for prognosis, the AU-ROC (Mean±SE) of HLA-DR+/CD14+ and APACHE Ⅱwere 0.813±0.049 (95%CI 0.716-0.910, P=0.00) and 0.825±0.052 (95% CI 0.724-0.926, P=0.000), respectively. The best cut-off for HLA-DR+/CD14+ was 36.0%, with the sensitivity of 94.1% and specificity of 50.0%. The best cut-off for APACHE Ⅱwas 20, with the sensitivity of 80.1% and specificity of 65.0%. Conclusion 　Low expression of HLA-DR+/CD14+ indicates hypoimmunity of geriatric trauma patients, and can play an significant role in predicting development of sepsis and poor prognosis. DOI: 10.11855/j.issn.0577-7402.2016.07.10