Abstract
ObjectiveTo investigate the expression of Programmed death-1 (PD-1) on T lymphocytes in patients with type 2 diabetes mellitus (T2DM) and severe sepsis, we determined PD-1 expression on CD4+ and CD8+ T lymphocytes of patients with T2DM, severe sepsis, and T2DM combined with severe sepsis.Research Design and MethodsThis prospective and observational study included 50 healthy controls, 80 cases of T2DM without infection (T2DM group), 88 cases of severe sepsis without T2DM (SS group), and 77 cases of severe sepsis combined with T2DM (SS+T2DM group). Expression of peripheral blood PD-1+ CD4+ T cells and PD-1+ CD8+ T cells were compared between these 4 groups. Then, 28-day survival of the SS and SS+T2DM patients was assessed, and the expression of PD-1 on T cells was also compared between survivors and non-survivors.ResultsPercentages of PD-1+ CD4+ T cells and PD-1+ CD8+ T cells were higher in the T2DM group than in the healthy control group, and were highest in the SS and SS+T2DM groups. However, the expression of PD-1 on T cells and the mortality showed no significant difference between the SS and SS+T2DM groups. The expression of PD-1 on T cells was higher in non-survivors than survivors, but within the survivor group or non-survivor group, no difference can be detected between those with T2DM and those without T2DM.ConclusionThe expression of PD-1 on T cells was increased in both T2DM and severe septic patients, but combining T2DM did not cause a further increase on the PD-1 expression in patients with severe sepsis.
Highlights
Sepsis is a common critical illness in clinical practice, and immunosuppression is an important cause of deterioration of severe sepsis [1]
Percentages of Programmed death-1 (PD-1)+ CD4+ T cells and PD-1+ CD8+ T cells were higher in the type 2 diabetes mellitus (T2DM) group than in the healthy control group, and were highest in the SS and SS+T2DM groups
It was found that PD-1 levels on peripheral blood T lymphocytes was increased in both the T2DM patients and those with severe sepsis compared to healthy controls, and those with severe sepsis showed higher PD-1 levels than T2DM, suggesting that both T2DM patients and those with severe sepsis had immune suppression
Summary
Sepsis is a common critical illness in clinical practice, and immunosuppression is an important cause of deterioration of severe sepsis [1]. With the increase in the incidence of type 2 diabetes mellitus (T2DM), its effect on sepsis and the underlying mechanism are attracting more and more attention [2]. Insulin resistance and insufficient insulin secretion are considered the core of this disease, which, doesn’t well explain the common clinical and biochemical characteristics seen in T2DM patients. More and more studies indicate that the pathogenesis of T2DM involves immune dysfunction, and T2DM can be considered somewhat a chronic inflammatory disease [3,4]. Impaired immunity in patients with diabetes may increase the risk of infection, the exact effect of diabetes on patients with severe sepsis remains to be studied
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