الفهرس 
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Abstract
Cirrhotic patients are prone to develop life-threatening complications that require emergency care and ICU admission. Cirrhotic patients admitted to intensive care units (ICU) still have poor outcomes.
The class II HLA-DR , molecules are heterodimers consisting of two noncovalently associated transmembrane glycoproteins. Class II molecules act as antigen receptors in the immune response , binding antigenic peptide fragments processed from exogenous antigens such as bacteria.
In cirrhosis, there is evidence for a dysfunctional and hyporesponsive state of the innate immune system.
This study aimed to evaluate the level of the HLA-DR on monocytes from blood samples of decompensated liver cirrhosis patients, normal appearing healthy control to test its usage as a prognostic marker for survival in the critically ill patient of liver cirrhosis.
The study included 40 decompensated liver cirrhosis patients, 5 were excluded by short term lenghth of stay in hospital, remainder 35 were classified into two groups; survivors group: 29 patients were subjected to estimation of HLA-DR on day 3,day 6, and day 9 of hospital admission and so called because they survived by follow up until discharged. Non survivors group: 6 patients were subjected to same pattern of HLA-DR estimation,but with following them up they died ,the cause of death was intractable deterioration of liver function and or multiple organ failure owing to severe late sepsis. Control group; 12 healthy volunteers with matched age and gender .
The present work showed the following :
The monocyte HLA-DR was lower in survivors group than control,and much lower in non survivors group than both other groups,this can be explained by
the down-regulation of monocyte HLA-DR level in cirrhotic patients and this down-regulation is markedly severe as the patient deteriorates.
The monocyte HLA-DR expression level (percent) was highly significantly lower in non survivors than survivors group of patient in the 1st,2nd and 3rd reading.
There was very highly significant dfference in survivors group of patients between 1st ,2nd and 3rd reading of monocyte HL-ADR that increased significantly, however non survivors group highly significantly decreased.
Regarding the non survivors group , there was significant increase in the C-reactive protein result from day 3 to day 9. However, when we compare 1st,2nd and 3rd readings in survivors there was non significant difference group with slight decrease in result of C-reactive protein fom the day 3 reading to day 9 reading in this group.
The monocyte HLA-DR expression levels in both survivors and non survivors groups of patients was lower than 30% , then increased in survivors and decreased in non survivors.
The causes of decompensation were not significantly different in both survivors and non survivors groups of pateints except for chest infection which was more in non survivors.