, Volume 196, Issue 1, pp 65–72 | Cite as

Prospective Observational Study on the Association Between Serum Mannose-Binding Lectin Levels and Severe Outcome in Critically Ill Patients with Pandemic Influenza Type A (H1N1) Infection

  • Elie Zogheib
  • Remy Nyga
  • Marjorie Cornu
  • Boualem Sendid
  • Julien Monconduit
  • Vincent Jounieaux
  • Julien Maizel
  • Christine Segard
  • Taïeb Chouaki
  • Hervé Dupont



Mannose-binding lectin (MBL) plays an important role in the innate immune response. In addition to activating the complement, MBL can induce cytokine production and contribute to a deleterious inflammatory response with severe A(H1N1)pdm09 virus infection. Our aim was to determine if serum MBL levels correlate with the risk of mortality in intensive care units (ICU) patients with A(H1N1)pdm09 infection.


Prospective observational study was performed in ICU patients with acute respiratory distress syndrome due to influenza A(H1N1)pdm09 virus. Demographic characteristics and severity indices were recorded at ICU admission. MBL was assayed from blood drawn at influenza diagnosis within 24–48 h following the ICU admission. Outcomes were compared according to MBL levels. Results are expressed as median and interquartile range.


Serum MBL levels were studied in 27 patients (age: 56 [IQR 29] years) with severe A(H1N1)pdm09 infection and in 70 healthy controls. Median admission SAPSII and SOFA scores were 49 [IQR 26] and 12 [IQR 5], respectively. Mortality rate after a 30-day was 37%. MBL was significantly higher in non-survivors (3741 [IQR 2336] ng/ml) vs survivors (215 [IQR 1307] ng/ml), p = 0.006, as well as control group (1814 [IQR 2250] ng/ml), p = 0.01. In contrast, MBL levels in survivors group were significantly lower than the controls group (215 [IQR 1307] ng/ml vs. 1814 [IQR 2250] ng/ml, p = 0.005). MBL cut-off > 1870 ng/ml had a sensitivity of 80% and a specificity of 88.2% for mortality [AUC = 0.82 (95% CI 0.63–0.94)]. Kaplan–Meier analysis demonstrated a strong association between MBL levels and mortality (log-rank 7.8, p = 0.005). MBL > 1870 ng/ml was independently associated with mortality (HR = 8.7, 95% CI 1.2–29.1, p = 0.007).


This study shows that baseline MBL > 1870 ng/ml is associated with higher mortality in ICU patients with severe A(H1N1)pdm09 infection.


Mannose-binding lectin Pandemic influenza A 2009 (H1N1) ICU Mortality 



Adjusted hazard ratio


Acute respiratory distress syndrome


Area under the curve


Bronchoalveolar lavage fluid


Chronic obstructive pulmonary disease


Extracorporeal membrane oxygenation


Intensive care unit


Interquartile range


Mannose-binding lectin


Negative likelihood ratio


Negative predictive value


Optical density


Positive likelihood ratio


Positive predictive value


Receiver operating characteristic


Real-time polymerase chain reaction


Simplified acute physiology score


Sequential organ failure assessment



The authors would like to thank all of the patients for their participation in this study. The cooperation of the medical and paramedical staff of intensive care units of the University Hospital, Amiens, France, is gratefully acknowledged.

Authors’ contributions

EZ, RN, TC, and HD contributed to the conception and design of the study. EZ, RN, and TC performed the acquisition of the data. HD performed the statistical analysis. EZ, RN, TC, JM, VJ, JM, CS, SB, and HD contributed to the analysis and interpretation of data, wrote and approved the final manuscript. EZ, RN, TC, JM, VJ, JM, CS, SB, and HD gave agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.


This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

Compliance with ethical standards

Conflict of interest

All the authors declare that they have no conflict of interest.

Ethical approval

This study was approved by the Institutional Review Board for Human Subjects.

Informed consent

Patients or relatives provided their informed consent.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2017

Authors and Affiliations

  • Elie Zogheib
    • 1
    • 2
  • Remy Nyga
    • 3
  • Marjorie Cornu
    • 4
    • 5
  • Boualem Sendid
    • 4
    • 5
  • Julien Monconduit
    • 6
  • Vincent Jounieaux
    • 6
  • Julien Maizel
    • 2
    • 7
  • Christine Segard
    • 8
  • Taïeb Chouaki
    • 3
  • Hervé Dupont
    • 1
    • 2
  1. 1.Cardiothoracic and Vascular Intensive Care UnitAmiens University HospitalAmiensFrance
  2. 2.INSERM U1088Jules Verne University of PicardyAmiensFrance
  3. 3.Medical Parasitology and Mycology DepartmentAmiens University HospitalAmiensFrance
  4. 4.Medical Parasitology and Mycology DepartmentCHULilleFrance
  5. 5.INSERM U995, Team Fungal Associated Invasive & Inflammatory Diseases, Lille Inflammation Research International CenterUniversité de LilleLilleFrance
  6. 6.Respiratory Intensive Care UnitAmiens University HospitalAmiensFrance
  7. 7.Medical Intensive Care UnitAmiens University HospitalAmiensFrance
  8. 8.Medical Virology DepartmentAmiens University HospitalAmiensFrance

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