The influence of sex hormones on human leukocyte antigen-DR, soluble myeloid cell receptor-1 and prognosis in patients with severe intra-abdominal infection

Abstract

To evaluate the influence of serum estradiol, prolactin and testosterone levels on human leukocyte antigen-DR (HLA-DR), soluble myeloid cell receptor-1 (sTREM-1) and prognosis in patients with severe abdominal infection, in order to evaluate the clinical value of the above-mentioned sex hormones. From July 10, 2009 to February 9, 2010, 73 cases with severe intra-abdominal infections hospitalized in surgical intensive care unit (ICU) of Tianjin Nankai Hospital were enrolled. Within 72 hours after enrollment, serum estradiol, prolactin and testosterone levels were detected by radioimmunoassay. Based on their levels, all the cases were divided into increased estradiol group (n=38) and non-increased estradiol group (n=35), increased prolactin group (n=28) and non-increased prolactin group (n=45), decreased testosterone group (n=33) and non-decreased testosterone group (n=40) respectively. In addition, HLA-DR (flow cytometry), as well as of sTREM-1 (enzyme linked immunosorbent assay), acute physiology and chronic health evaluation II (APACHEII) score, hospital days, the ICU length, hospital costs and 28 day mortality were recorded. Compared with non-increased estradiol group, HLA-DR in increased estradiol group decreased significantly [(61.22±22.39)% vs. (75.09±14.85)%], while sTREM-1 (ng/L) increased obviously (291.59±148.13 vs. 216.48±124.82), APACHEII score lowered dramatically (11.47±6.88 vs. 15.36±8.79), hospital costs (ten thousands) raised significantly (10.98±8.15 vs 6.25±3.51), ICU length (days) was much shorter (8.56±4.05 vs. 12.17±7.99), and 28 days mortality was significantly lowered (10.00% vs. 32.75%,P<0.05 or P<0.01). Compared with non-increased prolactin group, increased prolactin group had much lower HLA-DR levels [(61.19±21.50)% vs. (72.02±18.49)%], higher sTREM-1 levels (307.92±173.93 vs. 223.01±106.93), at the same time, their cost of hospitalization (7.75±3.52 vs. 11.36±8.24) and ICU stay length (9.14±3.15 vs. 13.24±2.16) were significantly lower (all P<0.05). Compared with non-decreased testosterone group, HLA-DR in decreased testosterone group increased significantly [(74.69±14.72)% vs. (62.24±22.54)%], while sTREM-1 decreased obviously (208.77±77.80 vs. 294.20±169.36), APACHEII score lowered dramatically (10.57±6.97 vs. 15.39±9.46), hospital costs decreased significantly (7.67±3.81 vs. 11.19±8.05), and 28 days mortality lowered significantly (0 vs. 30.14%, P<0.05 or P<0.01). In the early stage of severe intra-abdominal infection, estrogen, prolactin and testosterone levels had powerful influences on immune, inflammation, and prognosis, which may indicated a widespread clinical application.