Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India.
Department of Laboratory Oncology, All India Institute of Medical Sciences, New Delhi, India.
J Intensive Care Med. 2024 Feb;39(2):125-135. doi: 10.1177/08850666231193962. Epub 2023 Aug 9.
The dysregulated host immune response in sepsis is orchestrated by peripheral blood leukocytes. This study explored the associations of the peripheral blood leukocyte subpopulations with early clinical deterioration and mortality in sepsis.
We performed a prospective observational single-center study enrolling adult subjects with sepsis within 48 h of hospital admission. Peripheral blood flow cytometry was performed for the patients at enrolment and after 5 days. The primary outcome was to explore the association between various leukocyte subpopulations at enrolment and early clinical deterioration [defined as an increase in the sequential organ failure assessment (SOFA) score between enrolment and day 5, or death before day 5]. Other pre-specified outcomes explored associations of leukocyte subpopulations at enrolment and on day 5 with in-hospital mortality.
A total of 100 patients, including 47 with septic shock were enrolled. The mean (SD) age of the patients was 53.99 (14.93) years. Among them, 26 patients had early clinical deterioration, whereas 41 died during hospitalization. There was no significant association between the leukocyte subpopulations at enrolment and early clinical deterioration on day 5. On multivariate logistic regression, a reduced percentage of CD8 + CD25+ T-cells at enrolment was associated with in-hospital mortality [odds ratio (OR), 0.82 (0.70-0.97); p-value = 0.02]. A reduced lymphocyte percentage on day 5 was associated with in-hospital mortality [OR, 0.28 (0.11-0.69); p-value = 0.01]. In a post-hoc analysis, patients with "very early" deterioration within 48 h had an increased granulocyte CD64 median fluorescent intensity (MFI) [OR, 1.07 (1.01-1.14); p-value = 0.02] and a reduced granulocyte CD16 MFI [OR, 0.97 (0.95-1.00); p-value = 0.04] at enrolment.
None of the leukocyte subpopulations showed an association with early clinical deterioration at day 5. Impaired lymphocyte activation and lymphocytopenia indicative of adaptive immune dysfunction may be associated with in-hospital mortality.
脓毒症患者的宿主免疫反应失调是由外周血白细胞调控的。本研究旨在探讨外周血白细胞亚群与脓毒症患者早期临床恶化和死亡的关系。
我们进行了一项前瞻性观察性单中心研究，纳入了入院后 48 小时内的成年脓毒症患者。在入组时和第 5 天对患者进行外周血流式细胞术检测。主要结局是探讨入组时各种白细胞亚群与早期临床恶化[定义为入组时和第 5 天之间序贯器官衰竭评估（SOFA）评分增加，或第 5 天前死亡]之间的关系。其他预定的结局包括探讨入组时和第 5 天的白细胞亚群与住院死亡率之间的关系。
共纳入 100 例患者，其中 47 例为感染性休克患者。患者的平均（SD）年龄为 53.99（14.93）岁。其中 26 例患者发生早期临床恶化，41 例患者在住院期间死亡。入组时白细胞亚群与第 5 天的临床恶化无显著相关性。多变量 logistic 回归分析显示，入组时 CD8+CD25+T 细胞的百分比降低与住院死亡率相关[比值比（OR），0.82（0.70-0.97）；p 值=0.02]。第 5 天淋巴细胞百分比降低与住院死亡率相关[OR，0.28（0.11-0.69）；p 值=0.01]。在事后分析中，在 48 小时内发生“非常早期”恶化的患者，其粒细胞 CD64 中荧光强度（MFI）增加[OR，1.07（1.01-1.14）；p 值=0.02]，粒细胞 CD16 MFI 降低[OR，0.97（0.95-1.00）；p 值=0.04]。
入组时的白细胞亚群与第 5 天的早期临床恶化均无相关性。淋巴细胞激活受损和淋巴细胞减少表明适应性免疫功能障碍可能与住院死亡率相关。
