T Lymphocyte Subsets In Assesseing The Severity And Prognosis Of Patients With Sepsis

Objective:To investigate the value of T lymphocyte subsets in assessing the severity and prognosis of patients with sepsis;Methods:One hundred and thirty-eight patients with sepsis treated at the First Affiliated Hospital of Xinjiang Medical University from January 2016 to May 2022 were selected,and age,gender,site of infection,blood culture results,acute physiology and chronic health assessment(APACHE II)score,sequential organ failure(SOFA)score,T-lymphocyte subsets within 24 hours of admission(CD4~+,CD8~+,CD4~+/CD8~+ratio)and 28 d survival.The 138 sepsis patients were divided into sepsis group and septic shock group according to sepsis 3.0 diagnostic criteria;then divided into survival group and death group according to patients’28d prognosis,and compared the differences of the above indexes between the two groups.Linear correlation was used to analyze the correlation between the indexes and the severity of sepsis patients;multi-factor logistic regression was applied to analyze the independent risk factors for the prognosis of sepsis patients;the work characteristic curve(ROC)of subjects was drawn to assess the predictive value for the prognosis of sepsis patients.Result:There was no statistical significance(P＞0.05)in the comparison of age,gender,site of infection,and blood culture results between the two groups;compared with the sepsis group,there was a statistically significant decrease in CD4~+and CD4~+/CD8~+percentages and an increase in SOFA score and APACHE II score in the septic shock group(P＜0.05);comparing CD8~+in the septic shock group with the sepsis group,there was no statistical significance(P＞0.05);correlation analysis showed that there was a linear negative correlation between CD4~+and CD4~+/CD8~+ratio and APACHE II score with correlation coefficients of-0.524 and-0.244,respectively(both P＜0.05);CD4~+and CD4~+/CD8~+ratio were negatively correlated with SOFA score with correlation coefficients of-0.274,-0.189(both P＜0.05),and no correlation was found between CD8~+and APACHE II score and SOFA score(P＞0.05).No statistically significant correlation was found between the survival and death groups in terms of age,sex,and CD8~+(P＞0.05);compared with the survival group,the CD4~+and CD4~+/CD8~+ratio decreased and the SOFA score and APACHE II score increased in the death group,which was statistically significant(P＜0.05).Multifactorial logistic regression analysis of independent risk factors for 28-d prognosis in sepsis patients:CD4~+/CD8~+ratio,APACHE II score.The ROC curves plotted for CD4~+/CD8~+ratio and APACHE II score showed that the AUC of CD4~+/CD8~+ratio and APACHE II score for predicting 28 d death in sepsis were 0.756 and 0.779,respectively;the Jorden index was greatest at cut-off values of 1.49 and 14.50,respectively;the sensitivities were 83.3%and 65.0%,respectively The specificity was 59.0%and 79.5%,respectively.Conclusion:CD4~+and CD4~+/CD8~+ratios have a certain value in assessing the severity of sepsis patients;CD4~+/CD8~+ratio and APACHE II score are independent risk factors for sepsis 28 d death and have a predictive value for sepsis prognosis.