Jia Lijing, Long Ling, Wang Huawei, Ge Chen, Zhang Ze, Zhang Zhiyang, Zhao Heling
Department of Intensive Care Medicine, Hebei General Hospital, Shijiazhuang, People's Republic of China.
J Inflamm Res. 2025 May 27;18:6807-6819. doi: 10.2147/JIR.S517333. eCollection 2025.
Myeloid-derived suppressor cells (MDSCs), comprising polymorphonuclear (PMN-MDSCs) and monocytic subsets (M-MDSCs), are immunosuppressive immature myeloid cells implicated in disease progression and prognosis across multiple pathologies.
To investigate the clinical significance of early MDSCs subset expansion in critical illness and identify novel prognostic biomarkers for risk stratification.
This prospective study enrolled 85 critically ill adults (APACHE II ≥15), stratified into survivors (n=47) and non-survivors (n=38). MDSCs subsets were quantified via flow cytometry. Concurrent measurements included lactate, IL-6, CRP, lymphocyte subsets, and Tregs. Primary outcomes were 28-day all-cause mortality and secondary infection rates.
Survivors exhibited significantly higher M-MDSCs% (median [IQR]: 4.824 [1.863-9.776] vs 2.503 [1.480-5.224], P<0.05) and elevated M-MDSCs/PMN-MDSCs ratios (122.166 [34.220-307.500] vs 28.324 [5.042-88.128], P<0.01). Patients with M-MDSCs/PMN-MDSCs ratios ≥85.765 demonstrated markedly lower mortality (23.08% vs 59.19%; hazard ratio [HR] = 3.530, 95% confidence interval [CI]: 1.668-7.467, P<0.001), with the low-ratio group exhibiting a 2.56-fold higher mortality risk. A combined stratification model (M-MDSCs/PMN-MDSCs + APACHE II score) revealed a 7.48-fold increase in mortality in the low-ratio/high-APACHE II subgroup compared to the high-ratio/low-APACHE II subgroup (86.36% vs 11.54%, P<0.001).
Elevated levels of M-MDSCs in the early stages of critical illness may exert protective effects. The ratio of M-MDSCs/PMN-MDSCs demonstrates predictive value for 28-day mortality, positioning it as a potential biomarker for prognostic assessment, but further multicenter studies are still needed to validate it.
髓系来源的抑制细胞（MDSCs）包括多形核（PMN-MDSCs）和单核细胞亚群（M-MDSCs），是具有免疫抑制作用的未成熟髓系细胞，与多种疾病的进展和预后相关。
探讨危重症早期MDSCs亚群扩增的临床意义，并确定用于风险分层的新型预后生物标志物。
这项前瞻性研究纳入了85例危重症成人（急性生理与慢性健康状况评分系统II [APACHE II]≥15），分为幸存者（n=47）和非幸存者（n=38）。通过流式细胞术对MDSCs亚群进行定量分析。同时测量乳酸、白细胞介素-6（IL-6）、C反应蛋白（CRP）、淋巴细胞亚群和调节性T细胞（Tregs）。主要结局为28天全因死亡率和继发感染率。
幸存者的M-MDSCs%显著更高（中位数[四分位间距]：4.824 [1.863-9.776] 对2.503 [1.480-5.224]，P<0.05），且M-MDSCs/PMN-MDSCs比值升高（122.166 [34.220-307.500] 对28.324 [5.042-88.128]，P<0.01）。M-MDSCs/PMN-MDSCs比值≥85.765的患者死亡率显著更低（23.08%对59.19%；风险比[HR]=3.530，95%置信区间[CI]：1.668-7.46)。
