Parameters influencing membrane CD14 expression and soluble CD14 levels insepsis

Introduction: Membrane (mCD14) and soluble (sCD14) CD14 are pattern recogni tion receptors for bacterial cell wall fragments. They play an important ro le in the generation of the innate immune response against bacterial pathog ens. Differentia expression of these receptors may be relevant for the clin ical course of patients with sepsis. Patients and Methods: 32 patients with an early onset of sepsis (duration o f symptoms < 24h) were examined repeatedly by flow cytometry for expression of mCD14, and by ELISA for levels of sCD14, leukocyte elastase and C-react ive Protein (CRP). Results: At study entry, mCD14 expression was reduced in all patients with sepsis, but returned to normal levels during the course of the disease in s urvivors only. mCD14 was found to be inversely correlated with severity of disease, leukocyte elastase, and C-reactive protein. Among patients with se vere disease and Apache II scores greater than or equal to 20, sCD14 levels at study entry were significantly higher in those who survived by day 28, as compared to non-survivors (p = 0.02). Conclusion: The data presented are compatible with a recently published hyp othesis derived from in vitro experiments suggesting that leukocyte elastas e may be responsible for cleavage of mCD14 from the monocyte surface. The d ata also suggest that higher sCD14 levels may be beneficial in sepsis. Pers istently reduced mCD14 expression seems to be a marker for severity of dise ase in patients with sepsis.