Abstract
BackgroundEarly recognition of patients hospitalized for sepsis at higher risk of poor clinical outcome is a mandatory task and many studies suggested that indicators of the immune status may be useful for this purpose. We performed a retrospective, monocentric cohort study to evaluate whether lymphocyte subsets may be useful in predicting in-hospital mortality of septic patients.MethodsData of all consecutive patients with a diagnosis of sepsis at discharge and an available peripherical blood lymphocyte subset (CD4, CD8, CD16/CD56 and CD19) analysis at hospital entry were retrospectively collected between January 2015 and August 2018. Clinical characteristics of patients, past medical history and other laboratory parameters were also considered.ResultsTwo-hundred-seventy-eight septic patients, 171 (61.5%) males, mean age 63.2 ± 19.6 years, were enrolled. Total counts of lymphocytes, CD4 T cells, CD8 T cells and B cells were found significantly lower in deceased than in surviving patients. At univariate analyses, CD4 T cells/µL (OR 0.99 for each incremental unit, 95%CI 0.99–1.10, p < 0.0001), age (OR 1.06, 95%CI 1.04–1.09, p < 0.0001), procalcitonin (OR 1.01, 95%CI 1.01–1.02, p < 0.0001) and female gender (OR 2.81, 95%CI 1.49–5.28, p = 0.001) were associated with in-hospital mortality. When a dichotomic threshold of < 400/µL for CD4 T cells as a dependent variable was considered in multivariate models, age (OR 1.04; 95%CI 1.01–1.09, p = 0.018); female gender (OR 3.18; 95%CI 1.40–7.20, p = 0.006), qSOFA (OR 4.00, 95%CI 1.84–8.67, p < 0.001) and CD4 T cells < 400/µL (OR 5.3; 95%CI 1.65–17.00, p = 0.005) were the independent predictors.ConclusionsIn adjunct to biomarkers routinely determined for the prediction of prognosis in sepsis, CD4 T lymphocytes, measured at hospital entry, may be useful in identifying patients at higher risk of in-hospital death.
Highlights
Recognition of patients hospitalized for sepsis at higher risk of poor clinical outcome is a mandatory task and many studies suggested that indicators of the immune status may be useful for this purpose
Persistent lymphopenia has been associated with unfavorable outcome in patients with sepsis, and many studies suggested that quantitative and qualitative characterization of lymphocyte subsets may be useful to refine prediction of sepsis outcome [15,16,17,18,19,20]
We aimed to investigate the hypothesis that assay of circulating lymphocyte subsets at hospital entry may help predict in-hospital mortality in a large sample of patients hospitalized for sepsis at an Infectious Diseases Unit
Summary
Recognition of patients hospitalized for sepsis at higher risk of poor clinical outcome is a mandatory task and many studies suggested that indicators of the immune status may be useful for this purpose. Polilli et al BMC Infect Dis (2021) 21:780 organ dysfunction, but insufficient sensitivity was demonstrated in multiple settings, with the consequence of missed cases with occult hypoperfusion due to ensuing sepsis [3, 9]. Biomarkers such as C-reactive protein, Procalcitonin and Presepsin may have an important role in predicting patients’ prognosis, but all of them demonstrated insufficient sensitivity for this purpose in many settings of care [10,11,12,13].
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