Duration and magnitude of hypotension and monocyte deactivation in patients with community-acquired pneumonia

Peter M. Simon, Russell L. Delude, Minjae Lee, Lan Kong, Lynda J. Guzik, David T. Huang, Derek C. Angus, John A. Kellum

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

The objective was to examine the relationship of duration and magnitude of arterial hypotension to subsequent cellular immune suppression and cytokinemia in patients hospitalized with community-acquired pneumonia (CAP). We studied an observational cohort of 525 subjects hospitalized after presenting to the emergency department with radiographic and clinical signs of CAP. We compared the duration and magnitude of hypotension, using the cardiovascular Sequential Organ Failure Assessment (CV SOFA) subscore, to day 3 monocyte expression of human leukocyte antigen-DR (mHLA-DR), a previously validated marker of cellular immune suppression. A significant association of CV SOFA with decreased mHLA-DR expression was present in univariate analysis (P < 0.001) and persisted after adjustment for illness severity and other covariates (P = 0.01). With CV SOFA separated into components of magnitude and duration, after covariate adjustment, only duration was associated with day 3 mHLA-DR expression (P = 0.03). Levels of key proinflammatory and anti-inflammatory cytokines (interleukin 6 [IL-6], IL-10, tumor necrosis factor) increased with hypotension exposure and were also associated with mHLA-DR expression. In patients admitted with CAP, arterial hypotension over the first 3 days is associated with markers of monocyte deactivation. The duration of exposure to hypotension may be more important than the magnitude, and monocyte deactivation correlates with IL-6 and IL-10 release. These results suggest that persistent hypotension might contribute to immunosuppression following septic shock.

Original languageEnglish (US)
Pages (from-to)553-559
Number of pages7
JournalShock
Volume36
Issue number6
DOIs
StatePublished - Dec 1 2011

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Hypotension
Monocytes
Pneumonia
HLA Antigens
Interleukin-10
Interleukin-6
Septic Shock
Immunosuppression
Hospital Emergency Service
Anti-Inflammatory Agents
Tumor Necrosis Factor-alpha
Biomarkers
Cytokines

All Science Journal Classification (ASJC) codes

  • Emergency Medicine
  • Critical Care and Intensive Care Medicine

Cite this

Simon, P. M., Delude, R. L., Lee, M., Kong, L., Guzik, L. J., Huang, D. T., ... Kellum, J. A. (2011). Duration and magnitude of hypotension and monocyte deactivation in patients with community-acquired pneumonia. Shock, 36(6), 553-559. https://doi.org/10.1097/SHK.0b013e318235331e
Simon, Peter M. ; Delude, Russell L. ; Lee, Minjae ; Kong, Lan ; Guzik, Lynda J. ; Huang, David T. ; Angus, Derek C. ; Kellum, John A. / Duration and magnitude of hypotension and monocyte deactivation in patients with community-acquired pneumonia. In: Shock. 2011 ; Vol. 36, No. 6. pp. 553-559.
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Simon, PM, Delude, RL, Lee, M, Kong, L, Guzik, LJ, Huang, DT, Angus, DC & Kellum, JA 2011, 'Duration and magnitude of hypotension and monocyte deactivation in patients with community-acquired pneumonia', Shock, vol. 36, no. 6, pp. 553-559. https://doi.org/10.1097/SHK.0b013e318235331e

Duration and magnitude of hypotension and monocyte deactivation in patients with community-acquired pneumonia. / Simon, Peter M.; Delude, Russell L.; Lee, Minjae; Kong, Lan; Guzik, Lynda J.; Huang, David T.; Angus, Derek C.; Kellum, John A.

In: Shock, Vol. 36, No. 6, 01.12.2011, p. 553-559.

Research output: Contribution to journalArticle

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AU - Simon, Peter M.

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