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Abstract：
BACKGROUND: 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.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.
摘要：
背景：败血症中宿主免疫反应失调是由外周血白细胞协调的。这项研究探讨了外周血白细胞亚群与败血症早期临床恶化和死亡率的关系。
方法：我们进行了一项前瞻性单中心观察性研究，纳入入院后48小时内患有脓毒症的成年受试者。在登记时和5天后对患者进行外周血流式细胞术。主要研究结果是探讨不同白细胞亚群在入组时与早期临床恶化之间的关系[定义为入组和第5天之间的序贯器官衰竭评估(SOFA)评分增加,或第5天之前死亡]。其他预先指定的结果探讨了登记时和第5天白细胞亚群与住院死亡率的关系。
结果：共100名患者，纳入47例感染性休克患者.患者的平均（SD）年龄为53.99（14.93）岁。其中,26例患者出现早期临床恶化，而41人在住院期间死亡。登记时的白细胞亚群与第5天的早期临床恶化之间没有显着关联。在多元逻辑回归中，入组时CD8+CD25+T细胞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“非常早期”恶化的患者粒细胞CD64中位荧光强度（MFI）[OR，1.07（1.01-1.14）；p值=0.02]和减少的粒细胞CD16MFI[OR，0.97（0.95-1.00）；p值=0.04]。
结论：在第5天没有白细胞亚群与早期临床恶化相关。指示适应性免疫功能障碍的淋巴细胞活化受损和淋巴细胞减少可能与住院死亡率相关。
方法：我们进行了一项前瞻性单中心观察性研究，纳入入院后48小时内患有脓毒症的成年受试者。在登记时和5天后对患者进行外周血流式细胞术。主要研究结果是探讨不同白细胞亚群在入组时与早期临床恶化之间的关系[定义为入组和第5天之间的序贯器官衰竭评估(SOFA)评分增加,或第5天之前死亡]。其他预先指定的结果探讨了登记时和第5天白细胞亚群与住院死亡率的关系。
结果：共100名患者，纳入47例感染性休克患者.患者的平均（SD）年龄为53.99（14.93）岁。其中,26例患者出现早期临床恶化，而41人在住院期间死亡。登记时的白细胞亚群与第5天的早期临床恶化之间没有显着关联。在多元逻辑回归中，入组时CD8+CD25+T细胞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“非常早期”恶化的患者粒细胞CD64中位荧光强度（MFI）[OR，1.07（1.01-1.14）；p值=0.02]和减少的粒细胞CD16MFI[OR，0.97（0.95-1.00）；p值=0.04]。
结论：在第5天没有白细胞亚群与早期临床恶化相关。指示适应性免疫功能障碍的淋巴细胞活化受损和淋巴细胞减少可能与住院死亡率相关。
