Prognostic value of CD4+CD25+ Tregs as a valuable biomarker for patients with sepsis in ICU

doi:10.5847/wjem.j.1920-8642.2015.01.007

Abstract

Abstract:

BACKGROUND: Sepsis is a common complication of infections, burns, traumas, surgeries, poisonings, and post-cardiopulmonary resuscitation. The present study aimed to investigate prognostic value of CD4⁺CD25⁺ regulatory T cells (Treg) in peripheral blood of patients with sepsis.
METHODS: Periphery blood from 28 patients diagnosed with sepsis was collected on day 1 and 7 after hospitalization in the ICU of Shanghai Changzheng Hospital between December 2013 to April 2014. The blood was used for analyses of Treg ratio using flow cytometry and for analyses of blood routine test, C-reactive protein (CRP), bilirubin, procalcitonin (PCT), and coagulation. APACHE II and sequential organ failure assessment (SOFA) scores were also investigated. The results were compared between two outcome groups of survival or death to evaluate prognostic value for sepsis.
RESULTS: The patients had an average age of 60.36±15.03 years, APACHE II score 16.68±7.00, and SOFA score 7.18±3.78. Among the 28 patients, 12 had severe trauma (42.9%), 10 had septic shock (35.7%), and 9 (32.2%) died. The median ratio of Tregs was 2.10% (0.80%, 3.10%) in the survival group vs. 1.80% (1.15%, 3.65%) in the death group (Z=-0.148,P=0.883) on day 1; however it was significantly changed to 0.90% (0.30%, 2.80%) vs. 5.70% (2.60%, 8.30%) (Z=-2.905, P=0.004).
CONCLUSION: With better prospects for clinical application, dynamic monitoring of Tregs ratio in peripheral blood has potential value in predicting prognosis of sepsis.

Key words: CD4⁺CD25⁺ regulatory T cells, Sepsis, Prognosis, Biomarker, APACHE, SOFA, Procalcitonin

Kun Chen, Qiu-xiang Zhou, Hong-wei Shan, Wen-fang Li, Zhao-fen Lin. Prognostic value of CD4⁺CD25⁺ Tregs as a valuable biomarker for patients with sepsis in ICU[J]. World Journal of Emergency Medicine, 2015, 6(1): 40-43.

Figures/Tables 3

Table 1

Table 2

Table 3

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Parameters	Value
Age (mean±SD, year)	60.36±15.31
Sex (male/female)	22/6
APACHE II score (mean±SD)	16.68±7.00
SOFA score (mean±SD)	7.18±3.78
ICU LOS [median (25^th and 75^th ), days]	23.50 (12.25 and 31.75 )
Severe trauma (n, %)	12 (42.9 )
Septic shock (n, %)	10 (35.7 )
Source of infection (n, %)
Pneumonia	17 (43.59 )
Blood culture positive	10 (35.64 )
Intra-abdominal	4 (10.26 )
Urinary system	3 (7.69 )
Skin and soft tissue	2 (5.13 )
Other	3 (7.69 )
Pathogen (n, %)
Gram-negative bacteria	22 (64.71 )
Fungus	10 (29.41 )
Gram-positive bacteria	2 (5.88 )

Variables	All patients	Survivors	Non-survivors	Zvalue	Pvalue
Platelet [median (25^th, 75^th), ×10⁹/L]
Day 1	169.50 (74.50, 228.50 )	179.00 (119.00, 250.00)	98.00 (53.50, 192.50)	-1.870	0.062
Day 7	177.00 (127.50, 287.75)	201.00 (163.00, 310.00)	121.00 (60.00, 183.00)	-2.460	0.014
Procalcitonin median [(25^th, 75^th), ng/mL]
Day 1	4.27 (0.51, 8.26)	1.84 (0.39, 6.28)	8.47 (5.59, 14.15)	-2.730	0.006
Day 7	1.37 (0.26, 5.89)	0.74 (0.21, 2.00)	8.10 (4.42, 9.27)	-3.424	0.001
Endotoxin [day 7, median (25^th, 75^th), EU/mL]	0.68 (0.19, 0.42)	0.12 (0.04, 0.23)	0.48 (0.24, 0.74)	-2.583	0.010
D-dimer [day 7, median (25^th, 75^th), μg/ L]	2705.00 (1012.50, 4580.00)	1930.00 (800.00, 2800.00)	3870.00 (2825.00, 5310.00)	-2.533	0.011

Variables	All patients	Survivors	Non-survivors	Z value	P value
CD4⁺CD25⁺Tregs [day 1, median (25^th, 75^th), %]	2.10 (0.88, 3.10)	2.10 (0.80, 3.10)	1.80 (1.15, 3.65)	-0.148	0.883
CD4⁺CD25⁺Tregs [day 7, median (25^th, 75^th), %]	2.15 (0.70, 4.32)	0.90 (0.30, 2.80)	5.70 (2.60, 8.30)	-2.905	0.004
Δ_Tregs [(day 7-day 1), median (25^th, 75^th), %]	-0.10 (-1.38, 1.85)	-0.40 (-1.70, -0.10)	1.90 (1.55, 5.10)	-3.351	0.001

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