Guo Xue-Ling, Lu Cheng-Xiang, Luo Yan, Wang Ping-Ping, Su Wen-Song, Yang Si-Jiu, Zhan Ling-Hui
Department of Critical Care Medicine, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian, China.
The School of Clinical Medicine, Fujian Medical University, Fuzhou, Fujian, China.
J Chin Med Assoc. 2024 Dec 1;87(12):1068-1077. doi: 10.1097/JCMA.0000000000001177. Epub 2024 Oct 4.
This retrospective study investigated whether disturbances in circulating T-lymphocyte subsets could predict the incidence of acute kidney injury (AKI) and in-hospital mortality in patients with sepsis.
Clinical data from patients with sepsis admitted to the intensive care unit were reviewed. Logistic regression analyses were used to identify independent predictors of in-hospital mortality and the development of AKI.
Of 81 patients with sepsis, 50 developed AKI. Both nonsurvivors and patients with septic AKI exhibited higher Sequential Organ Failure Assessment (SOFA) and Acute Physiology and Chronic Health Evaluation (APACHE) II scores. Nonsurvivors exhibited more organ damage, with significantly lower levels of peripheral T-lymphocyte subsets, including total circulating lymphocytes, and CD3 + , CD3 + CD4 + , and CD3 + CD8 + T-lymphocytes. Patients with septic AKI exhibited fewer total peripheral lymphocytes and fewer CD3 + , CD3 + CD4 + , and CD3 + CD8 + T-lymphocytes, with higher serum lactate levels and lower nadir platelet counts. Independent predictors of 30-day hospital mortality included maximum SOFA and APACHE II scores, occurrence of encephalopathy, and peripheral CD3 + and CD3 + CD8 + T-lymphocyte counts. Moreover, the maximum SOFA score and CD3 + and CD3 + CD8 + T-lymphocyte counts demonstrated good predictive power for AKI in receiver operating characteristic (ROC) curve analyses, with an area under the ROC curve of 0.810 (95% confidence interval [CI], 0.712-0.908) for SOFA score, 0.849 (95% CI, 0.764-0.934) for CD3 + T-lymphocytes, and 0.856 (95% CI, 0.772-0.941) for CD3 + CD8 + T-lymphocytes.
Patients with sepsis-induced AKI experienced T lymphopenia and increased in-hospital mortality. Higher maximum SOFA scores and reduced peripheral CD3 + and CD3 + CD8 + T-lymphocyte levels were associated with in-hospital mortality and the development of AKI in patients with sepsis.
这项回顾性研究调查了循环T淋巴细胞亚群紊乱是否可预测脓毒症患者急性肾损伤（AKI）的发生率及住院死亡率。
回顾了重症监护病房收治的脓毒症患者的临床资料。采用逻辑回归分析确定住院死亡率及AKI发生的独立预测因素。
81例脓毒症患者中，50例发生了AKI。非存活者和脓毒症相关性AKI患者的序贯器官衰竭评估（SOFA）和急性生理与慢性健康状况评分系统（APACHE）II评分均更高。非存活者的器官损害更多，外周T淋巴细胞亚群水平显著更低，包括循环淋巴细胞总数以及CD3 +、CD3 + CD4 +和CD3 + CD8 + T淋巴细胞。脓毒症相关性AKI患者的外周淋巴细胞总数及CD3 +、CD3 + CD4 +和CD3 + CD8 + T淋巴细胞更少，血清乳酸水平更高，最低血小板计数更低。30天住院死亡率的独立预测因素包括最高SOFA评分和APACHE II评分、脑病的发生以及外周CD3 +和CD3 + CD8 + T淋巴细胞计数。此外，在受试者工作特征（ROC）曲线分析中，最高SOFA评分以及CD3 +和CD3 + CD8 + T淋巴细胞计数对AKI具有良好的预测能力，SOFA评分的ROC曲线下面积为0.810（95%置信区间[CI]，0.712 - 0.908），CD3 + T淋巴细胞为0.849（95%CI，0.764 - 0.934），CD3 + CD8 + T淋巴细胞为0.856（95%CI，0.772 - 0.941）。
脓毒症诱导的AKI患者出现T淋巴细胞减少及住院死亡率增加。脓毒症患者中，更高水平的最高SOFA评分以及更低的外周CD3 +和CD3 + CD8 + T淋巴细胞水平与住院死亡率及AKI的发生相关。
