RT Journal Article SR Electronic T1 Predicting the Outcomes of Subjects With Severe Community-Acquired Pneumonia Using Monocyte Human Leukocyte Antigen-DR JF Respiratory Care FD American Association for Respiratory Care SP 1635 OP 1642 DO 10.4187/respcare.03953 VO 60 IS 11 A1 Yugang Zhuang A1 Wenjie Li A1 Huiqi Wang A1 Hu Peng A1 Yanqing Chen A1 Xiangyu Zhang A1 Yuanzhuo Chen A1 Chengjin Gao YR 2015 UL http://rc.rcjournal.com/content/60/11/1635.abstract AB BACKGROUND: The objective was to study the level of monocyte-human leukocyte antigen-DR (mHLA-DR), an immune function-related biomarker, at 24 h after admission, to predict the outcomes of subjects with severe pneumonia.METHODS: Subjects with severe community-acquired pneumonia (n = 102) were included in the study. Blood samples were collected from each subject 24 h after admission. Data regarding age, sex, PaO2/FIO2, comorbidities, occurrence of altered mental status, bacteremia, septic shock, Acute Physiology and Chronic Health Evaluation (APACHE) II score, and Sequential Organ Failure Assessment (SOFA) score within the first 24 h; the highest temperature within 24 h after admission; mechanical ventilation usage; timing of antibiotic therapy; ICU stay; and 28-d survival were collected. Expression of mHLA-DR was measured by flow cytometry.RESULTS: APACHE II score and SOFA score were significantly higher (P < .001), whereas the mHLA-DR expression was significantly lower (P < .001) in the non-survivors than in the survivors. The outcomes at day 28 after admission were significantly associated with the APACHE II score (P = .002, odds ratio [OR] = 1.27, 95% CI 1.10–1.48), the SOFA score (P = .003, OR = 1.52, 95% CI 1.15–2.00), and mHLA-DR level (P = .01, OR = 0.91, 95% CI 0.85–0.98), as shown by logistic regression. The area under the receiver operating characteristic curve was 0.877 (95% CI 0.81–0.94, P < .001), 0.862 (95% CI 0.79–0.93, P < .001), and 0.781 (95% CI 0.69–0.87, P < .001) for APACHE II score, SOFA score, and the mHLA-DR expression, respectively. The optimal threshold for mHLA-DR level was 27.2%. Kaplan-Meier survival analysis showed that subjects with mHLA-DR ≥ 27.2% had significantly better outcomes compared with < 27.2% level (P < .001, log rank test, hazard ratio = 0.963, 95% CI 0.94–0.99).CONCLUSIONS: mHLA-DR may be a reliable biomarker that can predict the outcomes of patients with severe community-acquired pneumonia, and 27.2% may be the cut-off value to predict the outcomes.