Prognosis-related classifi cation and dynamic monitoring of immune status in patients with sepsis:A prospective observational study  

作　　者：Jun Yin Yao Chen Jun-ling Huang Lei Yan Zhong-shu Kuang Ming-ming Xue Si Sun Hao Xiang Yan-yan Hu Zhi-min Dong Chao-yang Tong Chun-xue Bai Zhen-ju Song 

机构地区：[1]Department of Emergency Medicine,Zhongshan Hospital,Fudan University,Shanghai 200032,China [2]Department of Respiratory and Critical Care Medicine,Zhongshan Hospital,Fudan University,Shanghai 200032,China

出　　处：《World Journal of Emergency Medicine》2021年第3期185-191,共7页世界急诊医学杂志（英文）

基　　金：the National Natural Science Foundation of China(81471840,81171837);the Shanghai Traditional Medicine Development Project(ZY3-CCCX3-3018,ZHYY-ZXYJH-201615);the Key Project of Shanghai Municipal Health Bureau(2016ZB0202).

摘　　要：BACKGROUND: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.METHODS: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.Classifi cation 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 classifi ed into four groups which were stabilization(SB),deterioration(DT),remission(RM),and non-remission(NR).RESULTS: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.CONCLUSIONS:Severe immune disorder defi ned as MARS or deterioration of immune status defi ned as DT lead to the worst outcomes.The preliminary model of the classifi cation and dynamic monitoring of immune status based on immune markers has prognostic values and is worthy of further investigation.

关 键 词：Infectious disease Immune dysfunction Immune status classifi cation CYTOKINE 

分 类 号：R459.7[医药卫生—急诊医学]