HLA-DR expression and soluble HLA-DR levels in septic patients after trauma

Ann Surg. 1999 Feb;229(2):246-54. doi: 10.1097/00000658-199902000-00013.


Objective: To determine if cellular and soluble HLA-DR molecules may be relevant in severely injured patients for the development of gram-positive or gram-negative sepsis.

Summary background data: HLA-DR molecules play a central role in the specific immune response to infection. The reduced HLA-DR expression on monocytes is considered to correlate with infectious complications and the development of sepsis. Data on the role of HLA-DR expression on T cells and soluble HLA-DR molecules are rare.

Methods: HLA-DR expression on monocytes and T cells was measured by flow cytometry. Plasma levels of soluble HLA-DR were studied by enzyme-linked immunosorbent assay.

Results: HLA-DR expression on circulating T cells, calculated as mean fluorescence intensity in channels, was reduced at day 1 after admission in 20 patients with subsequent severe sepsis compared with 46 patients without sepsis. The septic patients immediately after trauma had significantly lower soluble HLA-DR plasma levels than the nonseptic patients. At day 2 after admission, HLA-DR expression on monocytes was significantly lower in the severe sepsis group than in the patients without sepsis, and lasted until day 14 after injury.

Conclusions: In severely injured patients, decreased levels of cellular and soluble HLA-DR appear as early indicators of an immune deviation associated with the development of severe sepsis. Moreover, immune alterations of different cell types may promote distinct kinds of septicemia.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • HLA-DR Antigens / analysis
  • HLA-DR Antigens / biosynthesis*
  • HLA-DR Antigens / blood*
  • Humans
  • Injury Severity Score
  • Middle Aged
  • Monocytes / chemistry
  • Monocytes / metabolism
  • Prospective Studies
  • Sepsis / blood*
  • Sepsis / etiology
  • Sepsis / immunology*
  • T-Lymphocytes / chemistry
  • T-Lymphocytes / metabolism
  • Wounds and Injuries / complications*


  • HLA-DR Antigens