CD71+ Erythroid Cell Expansion in Adult Sepsis: Potential Causes and Role in Prognosis and Nosocomial Infection Prediction.

Guang-Ju Zhao,Yong-Ming Yao,Long-Wang Chen,Wen-Chao Cai,Bin Wu,Zhong-Qiu Lu,Xiao-Yan Chen,Wei Dong,Dan-Wei Jiang,Guang-Liang Hong

doi:10.3389/fimmu.2022.830025

Abstract

BackgroundImmune suppression contributes to nosocomial infections (NIs) and poor prognosis in sepsis. Recent studies revealed that CD71+ erythroid cells had unappreciated immunosuppressive functions. This study aimed to investigate the values of CD71+ erythroid cells (CECs) in predicting NIs and prognosis among adult septic patients. The potential factors associated with the expansion of CECs were also explored.MethodsIn total, 112 septic patients and 32 critically ill controls were enrolled. The frequencies of CD71+ cells, CD71+CD235a+ cells, and CD45+ CECs were measured by flow cytometry. The associations between CECs and NIs and 30-day mortality were assessed by ROC curve analysis and Cox and competing-risk regression models. Factors associated with the frequency of CECs were identified by linear regression analysis.ResultsThe percentage of CD71+ cells, CECs, and CD45+ CECs were higher in septic patients than critically ill controls. In septic patients, the percentages of CD71+ cells, CECs, and CD45+ CECs were associated with NI development, while CD71+ cells and CECs were independently associated with 30-day mortality. Linear regression analysis showed that the levels of interleukin (IL)-6 and interferon (IFN)-γ were positively associated with the frequencies of CD71+ cells, CECs, and CD45+ CECs, while IL-10 was negatively associated with them. Additionally, the levels of red blood cells (RBCs) were negatively associated with the percentage of CD45+ CECs.ConclusionsCECs were expanded in sepsis and can serve as independent predictors of the development of NI and 30-day mortality. Low levels of RBCs and high levels of IL-6 and IFN-γ may contribute to the expansion of CECs in sepsis.Trial RegistrationChiCTR, ChiCTR1900024887. Registered 2 August 2019, http://www.chictr.org.cn/showproj.aspx?proj=38645

Highlights

Sepsis and septic shock are major healthcare problems worldwide, and mortality and morbidity are still high [1]
This study aimed to investigate the values of CD71+ erythroid cells (CECs) in predicting nosocomial infection (NI) and prognosis among adult septic patients
CECs were expanded in sepsis and can serve as independent predictors of the development of NI and 30-day mortality

Summary

Introduction

Sepsis and septic shock are major healthcare problems worldwide, and mortality and morbidity are still high [1]. Sepsis is often accompanied by immune suppression, which is associated with increased occurrence of nosocomial infection (NI) and adverse outcomes [2, 3]. It is generally acknowledged that immunosuppression mainly occurs in the late stage of sepsis, but recent evidence shows that this phenomenon exists in the early stage of the disease and is closely related to the poor prognosis of patients [5,6,7]. Two subtypes of CD71+ erythroid cells (CECs) with different immunosuppressive abilities were identified on the basis of differential expression of CD45. Immune suppression contributes to nosocomial infections (NIs) and poor prognosis in sepsis. Recent studies revealed that CD71+ erythroid cells had unappreciated immunosuppressive functions. This study aimed to investigate the values of CD71+ erythroid cells (CECs) in predicting NIs and prognosis among adult septic patients. The potential factors associated with the expansion of CECs were explored

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