Biomarker to Predict Outcome in Children With Severe Sepsis

A recent study assessed the link between monocytic Human Leukocyte Antigen-DR (mHLA-DR) expression and outcome in children(aged 29 days to 15 years) with severe sepsis. It evaluated mHLA-DR expression (antigen bound per cell (ABC)) on two-time points, between 72 to 120 hours (P1) and 121 to 168 hours (P2), of stay in PICU and calculated the difference between the two as delta mHLA-DR. The study observed:

Enrollment of 47 children with a median age of 24 months and a median duration of illness of 3 days.

• Pediatric Logistic Organ Dysfunction (PELOD) score >10 in 63.8% of children. 
• Eighteen children succumbed. 
• Significantly higher median mHLA-DR levels (ABC) at P1 in children who survived than those who expired. 
• Higher median mHLA-DR levels (ABC) at P2 in those who survived than the expired group. 
• Higher median delta mHLA-DR levels (ABC) in the surviving group. 
• Significant association of mHLA-DR at 72 to 120 hrs, mHLA-DR at 121 to 168 hrs, and delta mHLA-DR with mortality but not with secondary infection. 
• A negative correlation between PELOD score and mHLA-DR at P1, at P2, and delta mHLA-DR. 
• The area under the curve of mHLA-DR expression (ABC) at P2 for a cutoff of < 6631 was 0.966 to predict mortality in severe sepsis. 

This study shows that mHLA-DR levels are significantly lower in children who succumbed than those who survived at both time points. Hence, it is a valuable biomarker for diagnosing the immune-paralysed state. 

Thangavel NP, Parameswaran N, Manivannan P, et al. Monocytic Human Leukocyte Antigen-DR Expression Levels to Predict Outcome in Children With Severe Sepsis. 2024 [E-PUB AHEAD OF PRINT]