Effect Of Early-stage Immunosuppression On Prognosis In Patients With Community-acquired Severe Sepsis

Objective To evaluate the effect of early-stage immunosuppression on prognosis in patients with community-acquired severe sepsis.Methods This was a prospective observational study. Patients with community-acquired sepsis admitted to ICU within 24 hours were included. Patients’ blood sample was collected on the day of admission (DO),3rd Day (D3) and 7th Day (D7) after admission. Th2, Thl and T reg in lymphocyte as well as the expression of HLA-DR in monocyte were tested by flow cytometry. The increase of Th2/Thl (>0.22) indicated immunosuppression. According to the change of Th2/Thl, patients were devided into 3 groups:immunosuppression recovered in early stage (Th2/Thl began to decrease on D3, Group 1), immunosuppression recovered in late stage (Th2/Thl began to decrease on D7, Group 2), immunosuppression worsened (Th2/Thl kept increasing in a week, Group 3). The organ dysfunction, HAI and prognosis was recorded.Results Forty-one patients were included in this study. One was withdrawn for epidemic diseases. Forty patients were eligible for study. There were 19 cases in Group 1,6 cases in Group 2, and 15 cases in Group 3.(1) Demographic data:there were no significant differences in terms of age,gender, infection sites, APACHE Ⅱ, SOFA, et al.(2) Effect of immunosuppression in early stage on systemic inflammatory response and immunity function:There were no significant differences in terms of systemic inflammatory response between three groups. On D0, there were no significant differences among three groups. On D3, Th2/Th1 of Group 2 (1.76[0.78,3.7]) and Group 3 (1.81 [0.45,3.31]) were higher than that of Group 1 (0.86 [0.35,2.12])(P< 0.05). On D7, compared with Group 1 (0.31 [0.08,1.18]), Th2/Thl of Group 3 (2.99[0.78,5.74]) was significantly higher on D7 (P<0.05).(3) Effect of immunosuppression in early stage on HAI, organ dysfunction and prognosis:There were no significant differences in terms of incidence of HAI and organ dysfunction (P>0.05). Compared with Group 1 (5.3%), Group 2 (33.3%) and Group 3 (53.3%) showed a significantly higher 28-day mortality (P<0.05).(4) Predictive effect of Th2/Thl to incidence of HAI and prognosis:The change of Th2/Thl between D7 and DO (ATh2/Th1D7-0) was of great value. △Th2/Th1D7-0 (>3.42) could predict HAI with sensitivity of 31% and specificity of 100%. ATh2/Th1D7-0 (>0.13) could predict death on 28th day with sensitivity of 90% and specificity of 83%.Conclusion Dynamic monitoring of immunity function is of great significance to prognosis. Patients with persistently increasing immunosuppression have bad prognosis.