Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing 100730, China.
Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing 100730, China.
Int J Infect Dis. 2020 Jul;96:315-322. doi: 10.1016/j.ijid.2020.04.072. Epub 2020 May 7.
This study investigated the use of lymphocyte subset counts as diagnostic and prognostic markers for carbapenem-resistant Enterobacteriaceae (CRE) infection.
We assessed the lymphocyte subset populations and other clinical parameters of septic patients upon intensive care unit (ICU) admission, and evaluated their potential impact on CRE infection diagnosis and outcome.
Among 373 septic patients, 51 were diagnosed with CRE infection. The 28-day mortality was significantly higher in CRE than non-CRE patients (35.3% vs 14.9%). The T lymphocyte count and CD4CD28 T cell count were both independent risk factors for CRE infection, with the latter had the best diagnostic ability (AUC: 0.908; p < 0.0001). Lower CD4CD28 T cell counts were associated with higher likelihoods of CRE infection. The CRE incidence and 28-day mortality of CRE-infected patients could be predicted using cutoff values of 242 (sensitivity: 83.9%; specificity: 87.5%) and 58.5 (sensitivity: 100%; specificity: 61.1%) CD4CD28 T cells/μl at ICU admission, respectively.
Septic patients with CRE infection had higher 28-day mortality. Given that the CD4CD28 T cell count was significantly lower in CRE than non-CRE septic patients and a lower cell count was significantly associated with higher 28-day mortality, CD4CD28 T cell counts may be useful markers for early diagnosis of CRE infection and outcome prediction.
本研究旨在探讨淋巴细胞亚群计数作为耐碳青霉烯肠杆菌科（CRE）感染的诊断和预后标志物的作用。
我们评估了重症监护病房（ICU）入院时脓毒症患者的淋巴细胞亚群和其他临床参数，并评估了它们对 CRE 感染诊断和结局的潜在影响。
在 373 例脓毒症患者中，51 例被诊断为 CRE 感染。CRE 组患者 28 天死亡率明显高于非 CRE 组（35.3% vs. 14.9%）。T 淋巴细胞计数和 CD4CD28 T 细胞计数均是 CRE 感染的独立危险因素，后者具有最佳的诊断能力（AUC：0.908；p<0.0001）。CD4CD28 T 细胞计数越低，发生 CRE 感染的可能性越大。通过使用 ICU 入院时 242（敏感性：83.9%；特异性：87.5%）和 58.5（敏感性：100%；特异性：61.1%）CD4CD28 T 细胞/μl 的截断值，可以预测 CRE 感染患者的发生率和 28 天死亡率。
患有 CRE 感染的脓毒症患者 28 天死亡率更高。鉴于 CRE 组与非 CRE 组脓毒症患者相比 CD4CD28 T 细胞计数明显更低，且细胞计数越低与 28 天死亡率越高显著相关，CD4CD28 T 细胞计数可能是早期诊断 CRE 感染和预测预后的有用标志物。
