Wang Chunmei, Tang Lunxian, Xu Huihui, Zhang Xiaoming, Bai Jianwen
Department of Emergency, Shanghai East Hospital of Tongji University, Shanghai 200120, China (Wang CM, Tang LX, Bai JW); Institute Pasteur of Shanghai, Chinese Academy of Sciences, Shanghai 200031, China (Xu HH, Zhang XM). Corresponding author: Bai Jianwen, Email:
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2017 Aug;29(8):673-678. doi: 10.3760/cma.j.issn.2095-4352.2017.08.001.
To explore the predicting value of peripheral blood CD20 CD24 CD38 regulatory B cells (Bregs) on the prognosis of elderly patients with sepsis.
A prospective study was conducted. Septic patients aged > 65 years old, compliance with diagnostic criteria for Sepsis-3, admitted to emergency and emergency intensive care unit (ICU) of Shanghai East Hospital of Tongji University from April 2016 to February 2017 were enrolled. Procalcitonin (PCT), C-reaction protein (CRP) and lactate (Lac) were routinely measured. According to the worst clinical index value within 24 hours, acute physiology and chronic health evaluation II (APACHE II) score and sequential organ failure assessment (SOFA) score were recorded. The concentrations of peripheral blood CD20 CD24 CD38 Bregs were measured by flow cytometry at 1, 3 and 7 days after diagnosed in elderly patients. All patients with sepsis were followed up for 28 days and then divided into death group and survival group according to 28-day outcome. The difference of clinic data and Bregs were compared between the two groups. The significant different factors of elderly sepsis patients were analyzed by binary logistic regression analysis. The correlation between Bregs level and other indicators was analyzed by Spearman correlation. The receiver operating characteristic curve (ROC) was used to evaluate the prognosis value of Bregs in elderly patients with sepsis.
Fifty-eight patients were enrolled in the study, with 38 male and 20 female; age of (79.91±7.97) years; 32 in sepsis group, 26 in septic shock group; 35 deaths, 28-day mortality rate was 60.3%. APACHE II score and SOFA score in death group exhibited much higher than that in survival group (APACHE II: 18.14±4.52 vs. 14.91±3.56, SOFA: 8.80±4.56 vs. 6.35±3.00, both P < 0.05), the Bregs was significantly decreased at 1, 3 and 7 days in death group [cells/μL: 0.70 (0.20, 1.40) vs. 1.50 (0.70, 2.20), 0.54 (0.20, 1.00) vs. 1.42 (1.10, 2.12), 0.25 (0.10, 0.50) vs. 0.80 (0.50, 1.00), all P < 0.05]. Correlation analysis showed that the concentrations of peripheral blood Bregs at 1 day in elderly patients with sepsis was negatively correlated with APACHE II score (r = -0.351, P = 0.007), and it was not correlated with PCT, CRP, Lac or SOFA score. It was shown by binary logistic regression that Bregs [odds ratio (OR) = 1.865, P = 0.028] and APACHE II score (OR = 0.853, P = 0.026) were independent risk factors for elderly sepsis outcome. It was shown by ROC curve analysis that the prognostic value of the levels of Bregs at 1, 3, 7 days and APACHE II score were higher in the elderly patients with sepsis, and the area under ROC curve (AUC) and 95% confidence interval (95%CI) were 0.842 (0.647-0.954), 0.770 (0.564-0.911), 0.888 (0.703-0.977), 0.855 (0.661-0.961), respectively, all P < 0.01. The 7-day Bregs was most powerful to predict outcome, when the cut-off value was 0.50 cells/μL, the sensitivity was 72.73% and specificity was 86.67%.
The level of peripheral blood CD20 CD24 CD38 Bregs could predict the clinical outcome of elderly patients with sepsis.
探讨外周血CD20 CD24 CD38调节性B细胞（Bregs）对老年脓毒症患者预后的预测价值。
进行一项前瞻性研究。纳入2016年4月至2017年2月在同济大学附属东方医院急诊科及急诊重症监护病房（ICU）收治的年龄>65岁、符合Sepsis-3诊断标准的脓毒症患者。常规检测降钙素原（PCT）、C反应蛋白（CRP）和乳酸（Lac）。根据24小时内最差临床指标值记录急性生理与慢性健康状况评分系统II（APACHE II）评分及序贯器官衰竭评估（SOFA）评分。老年患者确诊后1、3、7天采用流式细胞术检测外周血CD20 CD24 CD38 Bregs浓度。所有脓毒症患者随访28天，根据28天结局分为死亡组和存活组。比较两组临床资料及Bregs的差异。采用二元logistic回归分析老年脓毒症患者的显著差异因素。采用Spearman相关性分析Bregs水平与其他指标的相关性。采用受试者工作特征曲线（ROC）评估Bregs对老年脓毒症患者的预后价值。
本研究共纳入58例患者，其中男性38例，女性20例；年龄（79.91±7.97）岁；脓毒症组32例，脓毒性休克组26例；死亡35例，28天死亡率为60.3%。死亡组APACHE II评分及SOFA评分均显著高于存活组（APACHE II：18.14±4.52比14.91±3.56，SOFA：8.80±4.56比6.35±3.00，均P<0.05），死亡组1、3、7天Bregs均显著降低[细胞/μL：0.70（0.20，1.40）比1.50（0.70，2.20），0.54（0.20，1.00）比1.42（1.10，2.12），0.25（0.10，0.50）比0.80（0.50，1.00），均P<0.05]。相关性分析显示，老年脓毒症患者1天时外周血Bregs浓度与APACHE II评分呈负相关（r=-0.351，P=0.007），与PCT、CRP、Lac或SOFA评分无相关性。二元logistic回归显示，Bregs[比值比（OR）=1.865，P=0.028]及APACHE II评分（OR=0.853，P=0.026）是老年脓毒症预后的独立危险因素。ROC曲线分析显示，1、3、7天Bregs水平及APACHE II评分对老年脓毒症患者预后价值较高，ROC曲线下面积（AUC）及95%置信区间（95%CI）分别为0.842（0.647-0.954）、0.770（0.564-0.911）、0.888（0.703-0.977）、0.855（0.661-0.961），均P<0.01。7天Bregs对结局预测能力最强，截断值为0.50细胞/μL时，灵敏度为72.73%，特异度为86.67%。
外周血CD20 CD24 CD38 Bregs水平可预测老年脓毒症患者的临床结局。
