Longitudinal monocyte human leukocyte antigen-DR expression is a prognostic marker in critically ill patients with decompensated liver cirrhosis

Liver Int. 2009 Apr;29(4):536-43. doi: 10.1111/j.1478-3231.2008.01870.x. Epub 2008 Sep 15.


Background: Critical illness in cirrhotic patients is associated with a poor prognosis and increased susceptibility to infections. Monocyte HLA-DR expression is decreased in cirrhotic patients, but its prognostic value has not been investigated prospectively.

Methods: Thirty-eight critically ill patients with decompensated liver cirrhosis were included in this prospective study. On admission to the intensive care unit (ICU), inflammatory parameters (C-reactive protein, procalcitonin and lipopolysaccharide-binding protein), interleukin (IL)-10, interferon (IFN)-gamma serum levels, tumour necrosis factor (TNF)-alpha ex vivo stimulation (whole blood assay) and HLA-DR expression on monocytes (FACS analysis) were determined. Immune parameters were furthermore measured every third day until discharge from the ICU or death of the patients.

Results: Intensive care unit mortality of the cirrhotic patients was 34.2%. During admission, TNF ex vivo, IFN-gamma and HLA-DR expression were lower in non-survivors (all P<0.05), while IL-10 levels were increased in non-survivors compared with survivors (P=0.001). However, individual values clearly overlapped between groups. Prospective analysis revealed that monocyte HLA-DR expression remained stable or increased in survivors, but decreased in non-survivors (P=0.002). A decrease in HLA-DR expression between admission and day 3 was strongly associated with decreased IFN-gamma levels and increased ICU mortality (hazard ratio 3.36, P=0.008), mostly owing to late sepsis. This association was independent of the sequential organ failure assessment and model for end-stage liver disease score.

Conclusions: Here we establish the relative HLA-DR expression (admission/day 3) as a prognostic marker for ICU mortality in critically ill cirrhotic patients. These results may guide the evaluation of immune-modulating therapies in these patients.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Biomarkers / metabolism
  • Critical Illness
  • Female
  • HLA-DR Antigens / metabolism*
  • Humans
  • Intensive Care Units
  • Interleukin-6 / blood
  • Liver Cirrhosis / blood*
  • Liver Cirrhosis / mortality
  • Liver Failure / blood
  • Liver Failure / etiology
  • Liver Failure / mortality
  • Liver Failure / pathology
  • Male
  • Middle Aged
  • Monocytes / metabolism*
  • Prognosis
  • Prospective Studies
  • Survival Rate
  • Tumor Necrosis Factor-alpha / blood
  • Young Adult


  • Biomarkers
  • HLA-DR Antigens
  • IL6 protein, human
  • Interleukin-6
  • Tumor Necrosis Factor-alpha