Abstract
Purpose DDX3X acts as the critical checkpoint of death in stressed cells. The purpose of this study was to evaluate the mRNA expression level of DDX3X in T cells in peripheral blood of patients with sepsis and to explore its correlation with the prognosis of sepsis. Methods Seventy-nine patients with traumatic sepsis were enrolled in this prospective cohort study. Blood samples were collected within 24 hours after the diagnosis of sepsis or septic shock, and the mRNA expression level of DDX3X in T cells was detected by PCR. Results The level of DDX3X mRNA in T cells was significantly increased in septic patients as well as in septic shock patients. The level of DDX3X mRNA was negatively correlated with T cell count and positively correlated with acute physiological and chronic health assessment (APACHE) score and sequential organ failure assessment (SOFA) score (P < 0.01). The area under the curve (AUC) of the receiver operating characteristic (ROC) curve was 0.79 (95% confidence interval (CI), 0.68-0.90). A Cox proportional hazard model identified an association between an increased DDX3X mRNA level (≥1.575) and the risk of 28-day mortality (hazard ratio = 9.540, 95% CI, 2.452-37.108). Conclusions High level of DDX3X mRNA in T cells in sepsis is associated with the severity of sepsis and the mortality of patients with sepsis.
Highlights
Sepsis is a life-threatening organ dysfunction caused by an uncontrolled response to infection in hosts and is the leading cause of death in critically ill patients [1]
A previous study has found that lymphocytopenia and immunosuppression in patients with advanced sepsis were associated with CD4+ and CD8+ T cell apoptosis [3]
Spearman correlation coefficient analysis showed that DDX3X mRNA was significantly negatively correlated with T cell number (r = −0:36, P = 0:0012) (Figure 2(c)). These results suggest that DDX3X mRNA may be related to the loss of T cells
Summary
Sepsis is a life-threatening organ dysfunction caused by an uncontrolled response to infection in hosts and is the leading cause of death in critically ill patients [1]. Immunosuppression or immune paralysis is considered to be the main reason of long-term complications and death from sepsis [3]. A previous study has found that lymphocytopenia and immunosuppression in patients with advanced sepsis were associated with CD4+ and CD8+ T cell apoptosis [3]. Persistent immune imbalance leads some sepsis survivors to present with persistent inflammation, immunosuppression, and catabolic syndrome (PICS), characterized by a significant decrease in T lymphocytes [6, 7]. The design that targeted immunoregulatory therapy based on T cells is considered to be a potential measurement to improve the prognosis of sepsis
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