Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China.
Department of Critical Care Medicine, Changsha Central Hospital, Changsha 410004, China.
Int J Infect Dis. 2019 Jan;78:140-147. doi: 10.1016/j.ijid.2018.10.028. Epub 2018 Nov 3.
This study aimed to investigate the distinguishing ability of lymphocyte subtyping for Invasive candidiasis (IC) diagnosis and prognosis in non-neutropenic critically ill patients.
We assessed the quantitative changes in key parameters of lymphocyte subtyping at the onset of clinical signs of infection in non-neutropenic critically ill patients and their potential influence on diagnosis and outcome of IC. The primary outcome was 28-day mortality.
Among the 182 consecutive critically ill patients, 22 (12.1%) were in the IC group. The CD28CD8 T-cell counts (AUC 0.863, 95%CI 0.804-0.909, P<0.001) had greater diagnostic value for IC than other parameters had. Adding CD28CD8 T to Candida score significantly improved the predictive value of Candida score (P=0.039). Multivariate logistic regression analysis identified CD28CD8 T-cell counts≤78 cells/mm (OR 24.544, 95%CI 6.461-93.236, P<0.001) as an independent predictor for IC diagnosis. CD28CD8 T-cell counts could also predict 28-day mortality. Kaplan-Meier survival analysis provided evidence that CD28CD8 T-cell count <144cells/mm (log-rank test; P=0.03) were associated with lower survival probabilities.
CD28CD8 T-cell counts play an important role in early diagnosis of IC. Low counts are associated with early mortality in non-neutropenic critically ill patients. These results suggest the potential usefulness of measuring CD28CD8 T-cell lymphocyte levels in the early recognition and diagnosis of IC.
ChiCTR-ROC-17010750. Registered 28 February 2017.
本研究旨在探讨淋巴细胞亚群分型对非中性粒细胞减少危重症患者侵袭性念珠菌病（IC）诊断和预后的鉴别能力。
我们评估了非中性粒细胞减少危重症患者出现感染临床症状时淋巴细胞亚群分型关键参数的定量变化及其对 IC 诊断和结局的潜在影响。主要结局为 28 天死亡率。
在 182 例连续的危重症患者中，22 例（12.1%）为 IC 组。CD28CD8 T 细胞计数（AUC 为 0.863，95%CI 为 0.804-0.909，P<0.001）对 IC 的诊断价值大于其他参数。将 CD28CD8 T 细胞加入念珠菌评分显著提高了念珠菌评分的预测价值（P=0.039）。多变量 logistic 回归分析确定 CD28CD8 T 细胞计数≤78 个/ mm3（OR 为 24.544，95%CI 为 6.461-93.236，P<0.001）是 IC 诊断的独立预测因子。CD28CD8 T 细胞计数还可以预测 28 天死亡率。Kaplan-Meier 生存分析提供的证据表明，CD28CD8 T 细胞计数<144 个/ mm3（对数秩检验；P=0.03）与较低的生存率相关。
CD28CD8 T 细胞计数在 IC 的早期诊断中起重要作用。在非中性粒细胞减少的危重症患者中，计数较低与早期死亡率相关。这些结果表明，测量 CD28CD8 T 淋巴细胞水平在早期识别和诊断 IC 方面具有潜在的用处。
ChiCTR-ROC-17010750。于 2017 年 2 月 28 日注册。
