Abstract
Background The dynamic monitoring of immune status is crucial to the precise and individualized treatment of sepsis. In this study, we introduced a model to describe and monitor the immune status of sepsis and explored 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 day 1 and 3. Serum cytokines levels (TNF-α, IL-2R, IL-6, IL-8 and IL-10) and CD14 + monocyte HLA-DR expression were measured to serve as immune markers. Cut-off values were acquired from ROC curves and serum cytokine level higher than or HLA-DR level lower than cut point was defined as “positive”, otherwise defined as “negative”. Classification of each immune status, namely SIRS, CARS and MARS, was defined by numbers of positive immune markers levels. Changes of immune status from day 1 to 3 were classified 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. In univariate analysis, serum levels of TNF-α, IL-2R, IL-6, IL-8 and IL-10 and HLA-DR expression at day 1 and 3 were associated with prognosis. Multivariate analysis discovered IL-10 and HLA-DR expression at day 3 were independent prognostic factors. Patients with MARS at day 1 had the highest mortality rate up to 58.7% among three immune status classifications, so did the patient with MARS at day 3 with mortality rate up to 69.2%. Immune status of 46.1% patients changed from day 1 to 3. Among four groups of immune status changes, DT had the highest mortality rate up to 77.8% followed by NR, RM and SB with mortality rate of 64.7%, 42.9% and 11.2% respectively. Conclusions Patients with severe immune disorder defined as MARS or deterioration of immune status defined as DT have the worst outcomes. The preliminary model of the classification and dynamic monitoring of immune status based on immune markers levels has prognostic values and worthy of further investigation. Trail Registration: ChiCTR-OCC-14005202 (Chinese Clinical Trial Registry), Registered 09 September 2014, http://www.chictr.org.cn/showproj.aspx?proj=4373
Prognosis-related classification and dynamic monitoring of immune status in patients with sepsis: a prospective observational study