Association of monocyte HLA-DR expression over time with secondary infection in critically ill children: a prospective observational study

N.N. Hagedoorn, P. Kolukirik, N.M.A. Nagtzaam, D. Nieboer, S. Verbruggen, K.F. Joosten, H. Moll, G. Driessen, W.A. Dik, C. Vermont*

*Corresponding author for this work

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1 Citation (Web of Science)


An impaired immune response could play a role in the acquisition of secondary infections in critically ill children. Human leukocyte antigen-DR expression on monocytes (mHLA-DR) has been proposed as marker to detect immunosuppression, but its potential to predict secondary infections in critically ill children is unclear. We aimed to assess the association between mHLA-DR expression at several timepoints and the change of mHLA-DR expression over time with the acquisition of secondary infections in critically ill children. In this prospective observational study, children <18 years with fever and/or suspected infection (community-acquired or hospital-acquired) were included at a paediatric intensive care unit in the Netherlands. mHLA-DR expression was determined by flow cytometry on day 1, day 2-3 and day 4-7. The association between delta-mHLA-DR expression (difference between last and first measurement) and secondary infection was assessed by multivariable regression analysis, adjusted for age and Paediatric Logistic Organ Dysfunction-2 score. We included 104 patients at the PICU (median age 1.2 years [IQR 0.3-4.2]), of whom 28 patients (27%) developed a secondary infection. Compared to 93 healthy controls, mHLA-DR expression of critically ill children was significantly lower at all timepoints. mHLA-DR expression did not differ at any of the time points between patients with and without secondary infection. In addition, delta-mHLA-DR expression was not associated with secondary infection (aOR 1.00 [95% CI 0.96-1.04]).Conclusions: Our results confirm that infectious critically ill children have significantly lower mHLA-DR expression than controls. mHLA-DR expression was not associated with the acquisition of secondary infections.
Original languageEnglish
Pages (from-to)1133-1142
Number of pages10
JournalEuropean Journal of Pediatrics
Issue number3
Early online date10 Nov 2021
Publication statusPublished - Mar 2022


  • Immunosuppression
  • Secondary infection
  • Critical care
  • Pediatrics

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