Measurement of Monocyte CD86 Expression as Prognostic markers of Post Inflammatory Immunodeficiency in Critically Ill Patients

Post inflammatory immunodeficiency frequently becomes life threatening since patients are predisposed to nosocomial infection. MHC-II molecules are essential for the activation of CD4+ cells and therefore for the initiation of any adaptive immune response and enhancement of the innate immunity. Aim Of The Work: The aim of this work is to study the prognostic effect of the level of monocyte CD86 expression as an indicative of post inflammatory immunodeficiency states in critically ill patients. Also to study the relation of the level of monocyte CD86 to patient outcome. Study Design: This is a prospective non randomized control trial conducted in Critical Care Department, Faculty of medicine Cairo University, Egypt. Inclusion criteria: Twenty critically ill patients who were admitted to critical care department. Exclusion criteria was age more than 80 years, Age less than 18 years, Disseminated malignancy and Co-morbid severe organ dysfunction. All patients subjected to:1. History taken, 2. Complete detailed clinical examination, 3. vital signs 4. Complete blood count (CBC), Liver profile, Coagulation profile & Daily arterial blood gases. 5. Measurement of monocyte expressive co-stimulatory factor CD86 using systematic flow cytometry analysis technique starting from day 1 to day 4. Results: Out of the twenty patients 7 survivors and 13 non survivors. Age of the survivor group ranged from 30-60 years, non survivors age ranged from 35 to 70 years. Five out of 14 males (35.7%) were survivors as compared to 2/6 females (33.3%). There were statistically significant difference between both groups as regards higher mean of arterial blood pressure and central venous pressure in survivors, and a highly significant difference was encountered as regard higher hear rate, temperature and respiratory rate in non survivors. A highly statistically significant difference was encountered also as regards total leucocytic count, serum glutamic pyruvate transaminase, serum glutamic oxaloacetic transaminase, serum creatinine, prothrombin time and international normalized ratio which was higher in non survivors (P<0.001). Of the 7 surviving patients, only 30% showed positive blood culture; while in non survivors 70% of pts showed positive blood C/S and there was no statistically significant difference (P: 0.089). Positive sputum culture was encountered in 43% of the 7 surviving patients, and it was +ve in 70% of non survivors with borderline significance statistically (P: 0.05). In day 1 CD86 monocytes expression by mean fluorescent ratio showed statistically significant higher level in non survivors, in day 2 there were no statistically significant difference. In day 3 CD86 monocytes expression was higher in survivors and in day 4 both CD86 were statistically significant higher in the survivor group. Survivors vs non survivors mean fluorescent (4+2 vs 7+2.5) (4+2.4 vs 5+2.2, 6.3+2.1 vs 4.2+1.5 & 7+2.5 vs 3.5+1.6) with P value 0.01, 0.4, 0.0 & 0.001 respectively). The trend of CD86 expression change over the 4 days is presented as CD86 mean showed an increasing pattern in survivors. Conclusion: Semiquantitative measurement of CD86 level expressed by mean fluorescent ratio is a good and valid prognostic test of mortality in post inflammatory immuno deficiency patients. [F. Ragab, M. Khaled, A. Mahmoud Kamel, A. Abd El Bary, M. Abd El Monem Measurement of Monocyte CD86 Expression as Prognostic markers of Post Inflammatory Immunodeficiency in Critically Ill Patients] Life Science Journal, 2011; 8(4):943-950] (ISSN: 1097-8135). http://www.lifesciencesite.com. 121