Multi-center Clinical Study On PD-1 Expression Rate Of T Lymphocytes In Sepsis Patients

Objective: Monitoring the expression rate of programmed death factor-1(PD-1)on the surface of peripheral blood T cell in sepsis patients,and comparing the results of them at different stages to analyse the predictive value of PD-1expression on prognosis in sepsis patients.Methods: This study is a prospective,multicenter,observational approach.First portion,from January 2020 to December 2020,the patients with sepsis admitted to the Affiliated Hospital of Guilin Medical University,the Fifth Affiliated Hospital of Zunyi Medical University and the Donghua Hospital Affiliated to Sun Yat-sen University,and the health persons who were in these hospital for physical examination at the same time were selected as the subject investigated.Draw peripheral blood specimens at different stages,comparing the expression of peripheral blood lymphocyte PD-1 in healthy group and sepsis group on day 1,day 3 and day 7.Second portion,from January 2020 to December 2020,the patients with sepsis admitted to the Affiliated Hospital of Guilin Medical University,the Fifth Affiliated Hospital of Zunyi Medical University and the Donghua Hospital Affiliated to Sun Yat-sen University were selected as the subject investigated.According to the survival conditions of sepsis patients after 28 days,they were divided patients into survival group and death group.Recording and comparing the expression of PD-1 in survival and death groups at.The receiver operating characteristic(ROC)curve was used to analyze the predictive value of PD-1expression on prognosis in sepsis patients.Results:(1)First portion: From January 2020 to December 2020,189 sepsis patients were included in the sepsis group and 52 healthy people in the health group.The expression of PD-1 on the peripheral blood in sepsis group was higher than that in healthy group on the first,third and seventh days(P<0.05);(2)Second portion: According to the survival conditions of sepsis patients after 28 days,they were divided 189 patients into survival group(n=150)and death group(n=39).There was no significant difference in the expression of PD-1 between the survival group and the death group on the first days(P>0.05),but the expression of PD-1 in the death group were higher than those in the survival group on the third and seventh days(P <0.05);The areas under the ROC curve of PD-1 expression rate and APACHE Ⅱ score on the seventh days were 0.754(95% CI:0.633～0.875)and 0.791(95%CI:0.687～0.895).The areas under the ROC curve of PD-1expression rate combined with APACHE Ⅱ was 0.879(95% CI:0.795～0.963).When the optimal threshold value of PD-1 expression rate was 7.52%,the sensitivity was 92.3% and the specificity was 68.2%.When the APACHE Ⅱscore was 11.5,the sensitivity was 76.9% and the specificity was 36.4%.The Youden index of the serial test was greater than that of the parallel test,and their sensitivity and specificity were 71.0%,79.8%,and 98.2%,24.8%,respectively.Conclusions:(1)The expression of PD-1 was up-regulated in patients with sepsis.(2)The PD-1 expression rate of sepsis patients in death group is higher on the third and seventh days.(3)The combination of PD-1 expression and APACHE Ⅱ score has a higher specificity for the prognosis of sepsis.