Department of Medicine, University of Chicago Medical Center, Chicago, IL.
Department of Medicine, Rush University Medical Center, Chicago, IL.
Crit Care Med. 2020 Nov;48(11):1645-1653. doi: 10.1097/CCM.0000000000004610.
We recently found that distinct body temperature trajectories of infected patients correlated with survival. Understanding the relationship between the temperature trajectories and the host immune response to infection could allow us to immunophenotype patients at the bedside using temperature. The objective was to identify whether temperature trajectories have consistent associations with specific cytokine responses in two distinct cohorts of infected patients.
Prospective observational study.
Large academic medical center between 2013 and 2019.
Two cohorts of infected patients: 1) patients in the ICU with septic shock and 2) hospitalized patients with Staphylococcus aureus bacteremia.
Clinical data (including body temperature) and plasma cytokine concentrations were measured. Patients were classified into four temperature trajectory subphenotypes using their temperature measurements in the first 72 hours from the onset of infection. Log-transformed cytokine levels were standardized to the mean and compared with the subphenotypes in both cohorts.
The cohorts consisted of 120 patients with septic shock (cohort 1) and 88 patients with S. aureus bacteremia (cohort 2). Patients from both cohorts were classified into one of four previously validated temperature subphenotypes: "hyperthermic, slow resolvers" (n = 19 cohort 1; n = 13 cohort 2), "hyperthermic, fast resolvers" (n = 18 C1; n = 24 C2), "normothermic" (n = 54 C1; n = 31 C2), and "hypothermic" (n = 29 C1; n = 20 C2). Both "hyperthermic, slow resolvers" and "hyperthermic, fast resolvers" had high levels of G-CSF, CCL2, and interleukin-10 compared with the "hypothermic" group when controlling for cohort and timing of cytokine measurement (p < 0.05). In contrast to the "hyperthermic, slow resolvers," the "hyperthermic, fast resolvers" showed significant decreases in the levels of several cytokines over a 24-hour period, including interleukin-1RA, interleukin-6, interleukin-8, G-CSF, and M-CSF (p < 0.001).
Temperature trajectory subphenotypes are associated with consistent cytokine profiles in two distinct cohorts of infected patients. These subphenotypes could play a role in the bedside identification of cytokine profiles in patients with sepsis.
我们最近发现，感染患者不同的体温轨迹与生存相关。了解体温轨迹与宿主对感染的免疫反应之间的关系，可以使我们能够使用体温对患者进行床边免疫表型分析。本研究旨在确定在两个不同的感染患者队列中，体温轨迹是否与特定细胞因子反应具有一致的关联。
前瞻性观察性研究。
2013 年至 2019 年间的大型学术医疗中心。
两个感染患者队列：1）重症监护病房（ICU）中患有败血症性休克的患者；2）患有金黄色葡萄球菌菌血症的住院患者。
测量临床数据（包括体温）和血浆细胞因子浓度。在感染发生后的最初 72 小时内，根据患者的体温测量结果，将患者分为四个体温轨迹亚表型。将细胞因子水平进行对数转换并标准化为平均值，并与两个队列中的亚表型进行比较。
队列包括 120 例败血症性休克患者（队列 1）和 88 例金黄色葡萄球菌菌血症患者（队列 2）。来自两个队列的患者均被分为之前验证过的四个体温亚表型之一：“高热、缓慢缓解”（n = 19 队列 1；n = 13 队列 2）、“高热、快速缓解”（n = 18 队列 1；n = 24 队列 2）、“正常体温”（n = 54 队列 1；n = 31 队列 2）和“低体温”（n = 29 队列 1；n = 20 队列 2）。与“低体温”组相比，当控制队列和细胞因子测量时间时，“高热、缓慢缓解”和“高热、快速缓解”组的 G-CSF、CCL2 和白细胞介素 10 水平均较高（p < 0.05）。与“高热、缓慢缓解”不同，“高热、快速缓解”在 24 小时内多个细胞因子水平显著下降，包括白细胞介素 1RA、白细胞介素 6、白细胞介素 8、G-CSF 和 M-CSF（p < 0.001）。
在两个不同的感染患者队列中，体温轨迹亚表型与一致的细胞因子谱相关。这些亚表型可能在床边识别败血症患者的细胞因子谱方面发挥作用。
