Development and validation of immune dysfunction score to predict 28-day mortality of sepsis patients

被引：30

作者：

Fang, Wen-Feng ^{[1
,2
,3
]}

Douglas, Ivor S. ^{[4
,5
]}

Chen, Yu-Mu ^{[1
]}

Lin, Chiung-Yu ^{[1
]}

Kao, Hsu-Ching ^{[1
]}

Fang, Ying-Tang ^{[1
]}

Huang, Chi-Han ^{[1
]}

Chang, Ya-Ting ^{[1
]}

Huang, Kuo-Tung ^{[1
]}

Wang, Yi-His ^{[1
,2
]}

Wang, Chin-Chou ^{[1
,2
,3
]}

Lin, Meng-Chih ^{[1
,2
]}

机构：

[1] Chang Gung Univ, Coll Med, Kaohsiung Chang Gung Mem Hosp, Div Pulm & Crit Care Med,Dept Internal Med, Kaohsiung, Taiwan

[2] Chang Gung Univ, Coll Med, Dept Resp Therapy, Kaohsiung Chang Gung Mem Hosp, Kaohsiung, Taiwan

[3] Chang Gung Univ Sci & Technol, Dept Resp Care, Chiayi, Taiwan

[4] Univ Colorado, Div Pulm Sci & Crit Care Med, Denver, CO 80202 USA

[5] Denver Hlth Med Ctr, Denver, CO USA

来源：

PLOS ONE | 2017年 / 12卷 / 10期

关键词：

INTERNATIONAL CONSENSUS DEFINITIONS; SEPTIC SHOCK; IMMUNOMODULATORY THERAPIES; INDUCED IMMUNOSUPPRESSION; MONOCYTE DEACTIVATION; CLINICAL-CRITERIA; OUTCOMES; MANAGEMENT; SURVIVAL;

D O I：

10.1371/journal.pone.0187088

中图分类号：

O [数理科学和化学]; P [天文学、地球科学]; Q [生物科学]; N [自然科学总论];

学科分类号：

07 ; 0710 ; 09 ;

摘要：

Background Sepsis-induced immune dysfunction ranging from cytokines storm to immunoparalysis impacts outcomes. Monitoring immune dysfunction enables better risk stratification and mortality prediction and is mandatory before widely application of immunoadjuvant therapies. We aimed to develop and validate a scoring system according to patients' immune dysfunction status for 28-day mortality prediction. Methods A prospective observational study from a cohort of adult sepsis patients admitted to ICU between August 2013 and June 2016 at Kaohsiung Chang Gung Memorial Hospital in Taiwan. We evaluated immune dysfunction status through measurement of baseline plasma Cytokine levels, Monocyte human leukocyte-DR expression by flow cytometry, and stimulated immune response using post LPS stimulated cytokine elevation ratio. An immune dysfunction score was created for 28-day mortality prediction and was validated. Results A total of 151 patients were enrolled. Data of the first consecutive 106 septic patients comprised the training cohort, and of other 45 patients comprised the validation cohort. Among the 106 patients, 21 died and 85 were still alive on day 28 after ICU admission. (mortality rate, 19.8%). Independent predictive factors revealed via multivariate logistic regression analysis included segmented neutrophil-to-monocyte ratio, granulocyte-colony stimulating factor, interleukin-10, and monocyte human leukocyte antigen-antigen D-related levels, all of which were selected to construct the score, which predicted 28-day mortality with area under the curve of 0.853 and 0.789 in the training and validation cohorts, respectively. Conclusions The immune dysfunction scoring system developed here included plasma granulocyte-colony stimulating factor level, interleukin-10 level, serum segmented neutrophil-to-monocyte ratio, and monocyte human leukocyte antigen-antigen D-related expression appears valid and reproducible for predicting 28-day mortality.

引用

页数：16

共 38 条

[1] Compensatory anti-inflammatory response syndrome [J].