Jia Xi, Li Xiaojing, Miao Linzi, Bao Rong, Xiong Hui, You Ran, Lu Yao, Gui Xiaoning, Qu Chenxue
Department of Clinical Laboratory, Peking University First Hospital, Beijing, People's Republic of China.
Department of Clinical Laboratory, Baoding No.1 Central Hospital, Baoding, Hebei Province, People's Republic of China.
Infect Drug Resist. 2024 Nov 26;17:5215-5227. doi: 10.2147/IDR.S480864. eCollection 2024.
Sepsis causes substantial morbidity and mortality and constitutes a major public health problem. In patients with sepsis, immunosuppression is associated with poor prognosis, and immune monitoring during the early stages has prognostic value. This study aims to explore immunologic parameters associated with sepsis prognosis, potentially identifying patients who may benefit from immunotherapy, improving intensive care survival.
A total of 65 patients with sepsis from the Department of Emergency Medicine were divided based on survival at 28 days (47 in the survival group, 18 in the non-survival group). Peripheral blood was collected to measure absolute lymphocyte count and T lymphocyte subpopulations, including the percentage and absolute count of total T cells, CD4 T, CD8 T, and NK cells, and the percentages of naïve CD4 T, central memory CD4 T, effector CD4 T, effector memory CD4 T, naïve CD8 T, central memory CD8 T, effector CD8 T, effector memory CD8 T, CD4HLA-DR T, and CD8HLA-DR T cells, and Tregs. The differences in these parameters between the two groups were compared and a regression model was constructed to identify possible risk factors for death in patients with sepsis.
The absolute lymphocyte count, absolute T cell count (CD3, CD4, and CD8) and naïve CD4 T cell percentage were significantly lower in the non-survival group. Conversely, Tregs were higher in patients who did not survive sepsis. In regression analysis, the absolute lymphocyte count and naïve CD4 T cell percentage remained statistically significant. The receiver operating characteristic curve showed that a model based on the absolute lymphocyte count (435 cells/µL) and naïve CD4 T cell percentage (20.25%) performed best in predicting sepsis prognosis.
Monitoring of absolute lymphocyte count and analysis of T cell subtypes in the early phase of sepsis is predictive of outcome and may help identify those patients who would benefit from immunotherapy, improving survival.
脓毒症会导致严重的发病和死亡，是一个重大的公共卫生问题。在脓毒症患者中，免疫抑制与预后不良相关，早期的免疫监测具有预后价值。本研究旨在探索与脓毒症预后相关的免疫参数，潜在地识别可能从免疫治疗中获益的患者，提高重症监护生存率。
来自急诊科的65例脓毒症患者根据28天的生存情况进行分组（生存组47例，非生存组18例）。采集外周血以测量绝对淋巴细胞计数和T淋巴细胞亚群，包括总T细胞、CD4 T、CD8 T和NK细胞的百分比和绝对计数，以及初始CD4 T、中枢记忆CD4 T、效应CD4 T、效应记忆CD4 T、初始CD8 T、中枢记忆CD8 T、效应CD8 T、效应记忆CD8 T、CD4 HLA-DR T和CD8 HLA-DR T细胞以及调节性T细胞（Tregs）的百分比。比较两组这些参数的差异，并构建回归模型以识别脓毒症患者死亡的可能危险因素。
非生存组的绝对淋巴细胞计数、绝对T细胞计数（CD3、CD4和CD8）和初始CD4 T细胞百分比显著更低。相反，脓毒症未存活患者的Tregs更高。在回归分析中，绝对淋巴细胞计数和初始CD4 T细胞百分比仍具有统计学意义。受试者工作特征曲线显示，基于绝对淋巴细胞计数（435个细胞/µL）和初始CD4 T细胞百分比（20.25%）的模型在预测脓毒症预后方面表现最佳。
在脓毒症早期监测绝对淋巴细胞计数并分析T细胞亚型可预测预后，并可能有助于识别那些将从免疫治疗中获益的患者，提高生存率。
