Analysis of the Clinical Value of Monocyte Human Leukocyte Antigen-DR, Procalcitonin, and C-Reactive Protein in Sepsis

Abstract

Background

Sepsis is a life-threatening condition caused by a dysregulated host response to infection, leading to organ dysfunction. Early diagnosis and accurate prognosis are crucial for improving patient outcomes. Traditional biomarkers such as C-reactive protein (CRP) and procalcitonin (PCT) are widely used but have limitations in sensitivity and specificity. Monocytic human leukocyte antigen-DR (mHLA-DR) has emerged as a promising immunological marker reflecting immune status and severity in sepsis patients. This study aimed to compare the clinical value of mHLA-DR, PCT, and CRP in diagnosing and predicting sepsis outcomes, providing better guidance for clinical management.

Methods

A retrospective analysis was conducted on 83 sepsis patients and 86 non-sepsis patients admitted to the ICU of our hospital between August 2018 and July 2023. Sepsis patients with clear prognostic outcomes were divided into a survival (24 cases) and death groups (41 cases). Flow cytometry was used to detect mHLA-DR expression, while serum PCT and CRP levels were measured using an automated biochemical immunoassay analyzer. Differences in these indicators were compared between the sepsis and non-sepsis groups as well as between the survival and death groups. Receiver operating characteristic (ROC) curves were employed to analyze the diagnostic and prognostic values of these markers in sepsis.

Results

The mHLA-DR, PCT, and CRP levels were significantly higher in the sepsis group compared with the non-sepsis group (p < 0.001). The area under the ROC curve (AUC) values for diagnosing sepsis were 0.780 for mHLA-DR, 0.837 for PCT, and 0.839 for CRP, with optimal diagnostic cutoff values of 49.46%, 1.95 ng/mL, and 67.91 mg/L, respectively. The respective sensitivities were 76.7%, 86.7%, and 88.0%, while the respective specificities were 75.9%, 70.9%, and 64.0%. The combined analysis of these three indicators yielded an AUC value of 0.890 with an 86.7% sensitivity and 75.6% specificity. In the sepsis cohort, mHLA-DR expression levels were significantly higher in the survival group compared with the death group (p < 0.001), while PCT levels were significantly lower in the survival group (p = 0.045). CRP levels showed no significant difference between the survival and death groups (p = 0.833). The prognostic efficacy of mHLA-DR was significantly superior to that of PCT, with mHLA-DR displaying an AUC value of 0.841, an optimal cutoff value of 30.14%, and an 87.5% sensitivity and 73.2% specificity.

Conclusion

The combined application of mHLA-DR, PCT, and CRP could improve the diagnostic accuracy for sepsis. Overall, mHLA-DR is a significant biomarker for assessing immune suppression and prognosis in sepsis patients.