Abstract
The dynamic monitoring of immune status is crucial to the precise and individualized treatment of sepsis. In this study, we aim to introduce a model to describe and monitor the immune status of sepsis and to explore its prognostic value. A prospective observational study was carried out in Zhongshan Hospital, Fudan University, enrolling septic patients admitted between July 2016 and December 2018. Blood samples were collected at days 1 and 3. Serum cytokine levels (e.g., tumor necrosis factor-α [TNF-α], interleukin-10 [IL-10]) and CD14+ monocyte human leukocyte antigen-D-related (HLA-DR) expression were measured to serve as immune markers. Classification of each immune status, namely systemic inflammatory response syndrome (SIRS), compensatory anti-inflammatory response syndrome (CARS), and mixed antagonistic response syndrome (MARS), was defined based on levels of immune markers. Changes of immune status were classified into four groups which were stabilization (SB), deterioration (DT), remission (RM), and non-remission (NR). A total of 174 septic patients were enrolled including 50 non-survivors. Multivariate analysis discovered that IL-10 and HLA-DR expression levels at day 3 were independent prognostic factors. Patients with MARS had the highest mortality rate. Immune status of 46.1% patients changed from day 1 to day 3. Among four groups of immune status changes, DT had the highest mortality rate, followed by NR, RM, and SB with mortality rates of 64.7%, 42.9%, and 11.2%, respectively. Severe immune disorder defined as MARS or deterioration of immune status defined as DT lead to the worst outcomes. The preliminary model of the classification and dynamic monitoring of immune status based on immune markers has prognostic values and is worthy of further investigation.
Highlights
Sepsis is defined as a dysregulated host response to infection or other injury factors.[1,2] The incidence and prevalence of sepsis have increased over recent years, so sepsis accounts for a considerable number of intensive care unit (ICU) admissions and mortality.[3]
We aim to introduce a model of the immune status classification of sepsis based on immune markers and to explore the association between immune classification and prognosis
SIRS: systemic inflammatory response syndrome; CARS: compensatory anti-inflammatory response syndrome; MARS: mixed antagonistic response syndrome. a: percentage indicates the proportion of in-hospital survivors/non-survivors within each immune status; b: PA value was for the comparison between SIRS+CARS and MARS, and PB value was for the comparison between CARS and MARS
Summary
Sepsis is defined as a dysregulated host response to infection or other injury factors.[1,2] The incidence and prevalence of sepsis have increased over recent years, so sepsis accounts for a considerable number of intensive care unit (ICU) admissions and mortality.[3]. Sepsis is defined as a dysregulated host response to infection or other injury factors.[1,2]. The inflammatory activities of sepsis involve interactions between various inflammatory mediators. The early phase of sepsis features an activated inflammatory process caused by the systemic release of proinflammatory mediators.[6]. Sepsis can lead to the apoptosis and autophagy of immune cells, endotoxin tolerance, and relevant central nervous system regulation, which present as immunosuppression.[7]. Immunosuppression is more often observed in severe patients as a result of an imbalance between pro- and antiinflammatory activities.[6]. The dynamic monitoring of immune status is crucial to the precise and individualized treatment of sepsis. We aim to introduce a model to describe and monitor the immune status of sepsis and to explore its prognostic value
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