Han W, Wang H, Cui N, Zhang J H, Bai G X, Chen J W, Long Y
Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China.
Zhonghua Nei Ke Za Zhi. 2020 Dec 1;59(12):968-975. doi: 10.3760/cma.j.cn112138-20200430-00440.
To assess the diagnostic and prognostic value of lymphocyte subtyping for invasive candidiasis infection (ICI) in critically ill patients with non-neutropenic sepsis. A prospective observational cohort study was performed at Peking Union Medical College Hospital (PUMCH), 377 patients with non-neutropenic sepsis admitted to Department of Critical Care Medicine from January 2017 to November 2019 were enrolled. There were 9.0% (34/377) patients diagnosed as ICI. Vital signs, supportive care therapy and microbiological specimens were collected. Peripheral blood lymphocyte subtypes, serum globulin, complements, inflammatory factors such as interleukin(IL)-6, IL-8, IL-10 and tumor necrosis factor were detected within 24 hours after sepsis was diagnosed. The receiver operating characteristic (ROC) curve was used to evaluate the diagnostic value and prognostic significance of immunological indicators for ICI. Multiple logistic regression was used to analyze the independent risk factors for ICI. Kaplan-Meier analysis was used to analyze survival. The acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score was 17.0 (13.0, 21.0) in all 377 patients. The sequential organ failure score (SOFA) was 11.0 (8.0, 13.0), and the 28-day mortality rate was 27.6% (104/377). Peripheral blood CD8absolute T lymphocyte count≤177 cells/μl, CD28CD8T-cell count≤81 cells/μl and 1, 3-β-D-glucan (BDG) ≥88.20 ng/L were closely correlated with the diagnosis of ICI (AUC=0.793,95 0.749-0.833,0.000 1;AUC=0.892,95 0.856-0.921, 0.000 1;AUC=0.761, 95 0.715-0.803,0.000 1, respectively), with sensitivity of diagnosis 94.12%, 100.00%, and 88.24%; the specificity of diagnosis 81.34%, 62.39%, 63.56% respectively. Multivariate logistic regression analysis identified CD8T-cell count≤139 cells/μl (7.463, 95 1.300-42.831, 0.024) and CD28CD8T-cell counts≤52 cells/μl (57.494, 95 3.986-829.359, 0.003) as independent risk factors for higher mortality. Kaplan-Meier survival analysis suggested that CD8T-cell count ≤139 cells/μl (0.0159) and CD28CD8T-cell count≤52 cells/μl (0.000 1) were associated with higher mortality within 28 days (68.8%, 91.7%). Low CD28CD8T cell count in peripheral blood is closely related to the development and clinical outcome of ICI in sepsis patients, which could be used as an effective indicator for the diagnosis and prognosis prediction of ICI.
评估淋巴细胞亚群分型对非中性粒细胞减少的重症脓毒症患者侵袭性念珠菌感染（ICI）的诊断及预后价值。在北京协和医院进行了一项前瞻性观察队列研究，纳入2017年1月至2019年11月入住重症医学科的377例非中性粒细胞减少的脓毒症患者。有9.0%（34/377）的患者被诊断为ICI。收集生命体征、支持治疗及微生物标本。在脓毒症诊断后24小时内检测外周血淋巴细胞亚群、血清球蛋白、补体、炎症因子如白细胞介素（IL）-6、IL-8、IL-10及肿瘤坏死因子。采用受试者工作特征（ROC）曲线评估免疫指标对ICI的诊断价值及预后意义。采用多因素logistic回归分析ICI的独立危险因素。采用Kaplan-Meier分析评估生存情况。377例患者的急性生理与慢性健康状况评分Ⅱ（APACHEⅡ）为17.0（13.0，21.0）。序贯器官衰竭评分（SOFA）为11.0（8.0，13.0），28天死亡率为27.6%（104/377）。外周血CD8绝对T淋巴细胞计数≤177个/μl、CD28CD8T细胞计数≤81个/μl及1,3-β-D-葡聚糖（BDG）≥88.20 ng/L与ICI诊断密切相关（AUC分别为0.793，95%CI 0.749 - 0.833，P = 0.000 1；AUC为0.892，9%CI 0.856 - 0.921，P = 0.000 1；AUC为0.761，95%CI 0.715 - 。0.8；P = 0.000 1），诊断敏感性分别为94.1%、100.0%及88.24%；诊断特异性分别为81.34%、62.39%、63.56%。多因素logistic回归分析确定CD8T细胞计数≤139个/μl（比值比7.463，95%CI 1.300 - 42.831，P = 0.024）及CD28CD8T细胞计数≤52个/μl（比值比57.494，95%CI 3.986 - 829.359，P = 0.003）为高死亡率的独立危险因素。Kaplan-Meier生存分析提示CD8T细胞计数≤139个/μl（P = 0.0159）及CD28CD8T细胞计数≤52个/μl（P = 0.000 1）与28天内较高死亡率相关（分别为68.8%、91.7%）。外周血低CD28CD8T细胞计数与脓毒症患者ICI的发生及临床结局密切相关，可作为ICI诊断及预后预测的有效指标。
