The application of the HLA -DR expression on CD14 positive monocytes to the prognosis in major trauma patients

doi:10.3969/j.issn.1002-1949.2015.09.017

Abstract：Objective To investigate the variation of HLA -DR expression on CD14 positive monocytes ( HLA-DR CD14 +%) and the importance of HLA -DR CD14 +%using for the prognosis of patients with major trauma .Methods Seventy -nine patients with major trauma who admitted in the emergency and critical care center in General Hospital of Guangzhou Military Command from Jun , 2010 to Dec, 2012 were divided into survivor group ( n =54 ) and non -survivor group ( n =25 ) .The differences between two groups on age , gender, AIS -ISS scores, APACHEⅡscores, GCS scores, wound agent, injury portion, the members accepted emergency operation and immunotherapy , the level of procalcitonin (PCT) and HLA-DR CD14 +%were analyzed.The pattern of APACHEⅡand HLA-DR CD14 +%level were observed from 3rd to 7th day following the injury.ROC program and regression analysis were performed to evaluate the value of HLA -DR CD14 +% for the prognosis of patients with major trauma.Results There was no difference on the baseline between two groups (P>0.05).A significant correlation was found between APACHEⅡand HLA-DR CD14 +% level in these patients after the injury (P<0.05).However, the level of HLA-DR CD14 +% on 3rd day in non-survivor group was observed to decrease in comparison with the level in survivor group .And the value of APACHEⅡin non-survivor group presented to increase in comparison with the value in survivor group until 7th days.On 3rd day, the level of HLA-DR CD14 +%was statistically valuable to the outcome. The AUC in ROC program for predictive value of HLA -DR CD14 +% on 3rd day was 0.894. Moreover, the lower level of HLA -DR CD14 +%on 3rd day was a hazard risk for death by multivariate regression analysis . Conclusion The level of HLA -DR CD14 +% was reliably applied to the prognosis of the patients with major trauma .On 3rd day after injury , the lower value of HLA -DR CD14 +%was a hazard risk for death.