Depression of HLA-DR Expression by Monocyte in the Case of Postsurgical SIRS Correlates to Susceptibility of Postsurgical Infection

Yuji Imamura, Yoshio Takesue, Yoshio Ogura, Hiroki Ohge, Shinji Akagi, Yoshiaki Murakami, Eiso Hiyama^* and Takashi Yokoyama^*

First Department of Surgery, Hiroshima University, School of Medicine Department of General Medicine, Hiroshima University, School of Medicine^*

Depression of HLA-DR antigen expression by blood monocytes has been suspected of being correlated with deficiency of the immune response under systemic inflammation after injury. We studied the relationships between HLA-DR antigen expression by monocytes and the incidence of postoperative infection and risk factors (preoperative complications and treatment) in 28 patients who had systemic inflammatory response syndrome (SIRS) after digestive surgery. Twenty-one of the patients enrolled had postsurgical infection. Eight of them had a history of liver dysfunction (2), diabetes mellitus (5), chemotherapy (1), or irradiation (3), before the operation. The proportions of HLA-DR expressing cell among CD14 + monocytes on postoperative days (PODs) 1, 3, 7 were 52.4±6.2%, 63.0±7.0%, 71.8±6.3%, respectively. Each value was significantly lower than in patients who did not have any infection or had infection without risk factors. In patients with postsurgical infection with risk factors, the SIRS persisted until PODs 7, while patients without risk factors who had postsurgical infection recovered from SIRS by POD 5. Based on these results, postoperative SIRS in patients who have preoperative risk factors may be accompanied by immunosuppression, which exacerbates postsurgical infection. Estimation of monocyte HLA-DR expression was shown to be a method of predicting patient outocome during the postoperative course.

Key words
monocyte, HLA-DR, SIRS, postsurgical infection

Reprint requests
Yuji Imamura First Department of Surgery, Hiroshima University, Faculty of Medicine, School of Medicine 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551 JAPAN

Accepted
November 29, 2000

To read the PDF file you will need Abobe Reader installed on your computer.