CD14 EXPRESSION IN INJURED PATIENTS CORRELATES WITH OUTCOME

Objective The authors determined the correlation between monocyte CD14 expression and outcome in severely injured patients. Summary Backgrou nd Data Human leukocyte antigen-DR (HLA-DR) expression CD14 positive m onocytes correlates with the development of major infection and subseq uent death in severely injured patients. Recent studies show that CD14 is not only a marker for mature monocytes, but also is an important e ndotoxin/lipopolysaccharide receptor. Methods Flow cytometry data obta ined by dual staining techniques (CD14 and HLA-DR) of monocytes in 213 severely injured patients were analyzed over a 30-day period. Outcome criteria included survival and the development of both major and mino r infections. Results The percentage of cells expressing CD14(%CD14) c orrelated with clinical outcome, reaching significance (p < 0.05) betw een noninfected survivors (n = 74) and nonsurvivors (n = 21) at days 3 , 7, 11, 17, 24, and 30. At days 3, 7, and 17, the %CD14 also was diff erent between noninfected and infected survivors, After 7 days, differ ences were only seen between survivors and nonsurvivors (p < 0.05). Th e mean fluorescence intensity (MC CD14) in monocytes of all patients w as significantly reduced at day 3 compared with day 1 and remained low for 30 days (p < 0.05). The nonsurvivor group had consistently low MC CD14 values, which were significant at day 5 (p < 0.05). Conclusions In addition to HLA-DR expression, CD14 expression on monocytes is an i ndicator of clinical outcome after injury and could represent a more p recise target for treatment.