Skip to main content

Expression of mRNA levels of HLA-DRA in relation to monocyte HLA-DR: a longitudinal sepsis study


Decreased monocyte surface HLA-DR (mHLA-DR) measured by flow cytometry (FCM) is an independent marker of immunosuppression in sepsis. In a previous report we demonstrated that septic patients display a strong correlation between mHLA-DR and mRNA-levels of HLA-DRA in whole blood [1]. mRNA-based HLADR monitoring by PCR would improve the clinical usage and facilitate conduction of multicentre studies. The primary focus in this study was to evaluate the correlation between mHLA-DR and HLA-DRA at different time points during sepsis. In addition, we assessed the dynamic expression of both mHLA-DR and HLA-DRA, in relation to sepsis severity.


Study patients (n = 54) were included at day 1 to 2 after hospital admission if blood cultures turned positive. Repeated sampling at days 1 to 2, 3, 7, 14 and 28 was performed. mHLA-DR was monitored by FCM and HLA-DRA by quantitative RT-PCR. Mixed models for longitudinal data were used after logarithmic transformation to calculate the interactional effects of time and severity on HLA-DR expression.


Correlation between mHLA-DR(FCM) and HLA-DRA(PCR) at day 1 to 2 (R = 0.78) and day 14 (R = 0.27). Both HLA-DR markers increased linearly on a log scale over time. The linear association was significantly different between the severe (n = 16) and nonsevere septic patients (n = 38) when measuring either mHLA-DR(FCM) or HLA-DRA(PCR). By pairwise comparison of means between the two severity groups, at every time point, the differences between groups were shown to be significant at days 1 to 2 and 3 when monitoring mHLA-DR(FCM) and at days 1 to 2, 3 and 7 for HLA-DRA(PCR) (Figures 1 and 2).

Figure 1
figure 1

Box plots of mHLA-DR, measured by flow cytometry.

Figure 2
figure 2

Box plots of HLA-DRA, measured by qRT-PCR.


The correlation between flow cytometry and PCR-based HLA-DR monitoring is stronger in the early phase of sepsis. However, the linear associations over time, in relation to sepsis severity, display similar results for both HLA-DR markers. HLA-DRA(PCR) as a biomarker could be an alternative approach in monitoring immune status in sepsis but needs to be evaluated in relation to clinically relevant immunosuppression.


  1. Cajander S, et al: Crit Care. 2013, 17: R223-10.1186/cc13046.

    Article  PubMed Central  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations


Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Cajander, S., Tina, E., Bäckman, A. et al. Expression of mRNA levels of HLA-DRA in relation to monocyte HLA-DR: a longitudinal sepsis study. Crit Care 19 (Suppl 1), P45 (2015).

Download citation

  • Published:

  • DOI:


  • Flow Cytometry
  • Hospital Admission
  • Blood Culture
  • Sepsis Severity
  • Longitudinal Data