| Objective:Explore the influence of sepsis associated encephalopathy on the severity of patients;explore the correlation between the expression of CD3+CD56+NKT cell subsets with both the expression of co-signal molecules and septic encephalopathy;screen the related risk factors of septic associated encephalopathy and explore their prognostic value.Methods:A prospective observational study was conducted by enrolling sepsis patients meets the Sepsis3.0 criteria.The study was performed from February 2017 to May 2019.The inclusion criteria were sepsis patients,aged>18-years-old,who met the sepsis 3.0 criteria.SAE was defined as Sepsis patients with altered mental status,behavioral or cognitive abnormalities that exclude other reasons can affect cognitive,and a decreased score on the Glasgow Coma Scale(GCS).All patients were evaluated in the ICU on day 1(within 24 h after admission)and administered conventional therapy according to the 2016 international guidelines for the management of severe sepsis and septic shock.Compare the difference between SAE and non-SAE group;Analyze and screen the independent risk factors of SAE,establish a diagnostic model,and further analyze the diagnostic value of each index for SAE and the predictive value for 28-day death,and verify it by K-M survival analysis;Analyze the correlation between the expression of co-signal molecules of CD3+CD56+NKT cell subsets and inflammatory factors,organ function and prognosis of patients.Results:SAE was observed in 57 patients,with an estimated score on GCS of 6(5.5 10),the other 33 patients were considered as non-SAE.Mortality(in-hospital 18(31.6%)VS.4(12.1%),p=0.038,28-day 19(33.3%)VS.4(12.1%),p=0.026)was much higher in SAE patients than non-SAE patients,and APACHE Ⅱ score(22(16.3 25)VS.11(8.5 16),p<0.01)together with SOFA score(9(6 11)VS.6(4 8),p<0.01)were parallel with this result.Comparing MFI of CD86+in CD3+CD56+NKT cells,it is much higher in nonSAE than SAE group[2065.8(1625.5～3198.8)VS.3117.8(2278.1～5349),p=0.007],while no significant difference in cell count.Besides,compared with non-SAE patients,SAE patients were associated with higher CK,CK-MB,D-dimer,PCT,N-L ratio,PLTL.ratio,PLT-T cell ratio,Neu-T cell ratio(p<0.05),while albumin was much lower(p<0.05).We select the variables According to the univariate analysis ofp<0.05,using Logistics regression model to analyze the independent risk factors of SAE.Stratified MFI of CD86+in CD3+CD56+NKT,albumin,and APACHE Ⅱ score were the independent risk factors of SAE.the model showed an ideal performance in the diagnosis of SAE with an AUC of 0.894(95%CI:0.817 0.970,p<0.001)and Youden index of 0.727.Moreover,we compared the model with other 3 factors:APACHE Ⅱ(p=0.037),ALB(p<0.001),MFI of CD86 in CD3+CD56+NKT cells(p<0.001).Indicating that the SAE diagnosis by the model was better than the other isolated indicator.Then,the ROC curve coordinates were used to calculate the best cut-off value for the 28-day mortality prediction of the model,and the patients were divided into high-risk groups and lowrisk groups,and K-M survival analysis was performed.The results showed that the mortality rate of the high-risk group was significantly higher than that of the low-risk group(χ2=14.779,p<0.001).we performed a correlation analysis between MFI of CD86 in CD3+CD56+NKT cells and both inflammation biomarkers and clinical severity.NLR,PLT-T ratio,N-T ratio,P-CD4T ratio,P-CD8T ratio,N-CD8T ratio,N-CD4T ratio indicated a significant correlation with MFI of CD86 in CD3+CD56+NKT cells,all of them were in negative correlation.Conclusion:1.Patients in the SAE group were more severe,with worse organ dysfunction and higher mortality.2.MFI of CD86 in CD3+CD56+NKT cells,serum albumin,and APACHE Ⅱ score are the independent risk factors for sepsis-associated encephalopathy.3.CD86 expression in NKT cells of sepsis patients may mediate the occurrence of SAE by regulating the inflammatory response. |
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