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Published on: January 3, 2013
[The prognostic role of the programmed death-1 expression on T lymphocytes in septic patients]
1Department of Critical Care Medicine, Zhejiang Hospital, Hangzhou 310013, China.
Insights
Programmed death-1 (PD-1) expression on T cells is a significant predictor of mortality in sepsis patients. Higher PD-1 levels on T lymphocytes indicate a greater risk of 28-day death, suggesting its prognostic value.
Area of Science:
- Immunology
- Critical Care Medicine
- Sepsis Pathophysiology
Background:
- Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection.
- T lymphocytes play a crucial role in the immune response during sepsis.
- Programmed death-1 (PD-1) is an immune checkpoint receptor expressed on T cells, modulating immune responses.
Purpose of the Study:
- To evaluate the prognostic significance of programmed death-1 (PD-1) expression on T lymphocytes in patients with sepsis.
- To determine if PD-1 expression levels can predict 28-day mortality in septic patients.
Main Methods:
- A cohort of 64 septic patients was studied across six hospitals.
- Flow cytometry was used to measure PD-1 expression on T cells (CD3+, CD4+, CD8+).
- Logistic regression and ROC curve analysis were employed to assess risk factors and predictive value for mortality.
Main Results:
- Septic patients who died within 28 days exhibited significantly higher PD-1 expression on T cells compared to survivors (P<0.05).
- PD-1 expression on CD3+, CD4+, and CD8+ T cells were identified as independent risk factors for 28-day mortality.
- PD-1+ T cell percentages demonstrated significant area under the curve (AUC) values, indicating strong predictive capabilities for mortality.
Conclusions:
- T cell PD-1 expression serves as an independent risk factor for predicting 28-day mortality in sepsis.
- Combining the proportions of PD-1+ T cells (CD3+, CD4+, CD8+) may enhance the predictive accuracy for sepsis-related death.
Abstract:
Objective: To investigate the value of programmed death-1（PD-1） expression on the T lymphocytes for the prognosis of septic patients. Methods: From September 2017 to May 2019, septic patients were included in Department of Intensive Care Unit at 6 hospitals. The PD-1 expression on T cells were measured by flow cytometry. Logistic regression was conducted to analyze independent risk factors related to death within 28 days，and receiver operating characteristic curve(ROC) was conducted to evaluate the prognostic value of PD-1 expression on T cells in septic patients. Results: A total of 64 septic patients were enrolled to this study，including 32 survivors and 32 deaths. The PD-1 expression on T cells in the death group was significantly higher than that in the surviving group (P<0.05). Correlation analysis showed that the percentages of PD-1+/CD3+T cells and PD-1+/CD8+T cells were positively correlated with procalciton in (r=0.313, P =0.015；r=0.375, P=0.003), logistic regression analysis showed that the percentages of PD-1+/CD3+，PD-1+/CD4+，PD-1+/CD8+T cells were independent risk factors for the death of sepsis patients. The percentage of PD-1+/CD3+T cell was 3.63%, with AUC 0.842, sensitivity to predict the mortality 96.43% and specificity 59.38%, (P<0.000 1). The percentage of PD-1+/CD4+T cell was 4.65%, with AUC 0.847, sensitivity 96.43%, specificity 62.50%，(P<0.000 1). The percentage of PD-1+/CD8+T cell was 3.91%, with AUC 0.771, sensitivity 64.29%, specificity 81.25%，(P=0.000 3). Conclusions: The T cell PD-1 expression is an independent risk factor to predict the 28-day mortality in septic patients. Combining the proportions of PD-1+/CD3+, PD-1+/CD4+and PD-1+/CD8+T cells may further enhance the predictive value for death.
