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Published on: October 19, 2021
Intracellular ATP Levels in CD4+ T Lymphocytes as a Prognostic Marker for 28-Day Mortality in Adult ICU Patients with
Lijing Fan1, Hongbin Hu1, Zhili Liang1
1Department of Critical Care Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, 510515, People's Republic of China.
Objective:
To systematically evaluate the prognostic significance of CD4⁺ T-cell intracellular adenosine triphosphate (iATP)-derived parameters in adult ICU patients with sepsis, and to explore whether integrating stimulated iATP (s-iATP) with the APACHE II score provides additional prognostic information for 28-day mortality prediction.
Methods:
This single-center retrospective cohort study included adult ICU patients with sepsis admitted between May 2022 and March 2024. CD4⁺ T-cell iATP parameters, including s-iATP, non-stimulated iATP (n-iATP), the difference (s-n iATP), and the ratio (s/n iATP), were measured within 24 hours of sepsis diagnosis. Associations between iATP parameters and clinical outcomes, particularly 28-day mortality, were evaluated using survival and predictive analyses, and the prognostic value of combining s-iATP with the APACHE II score was assessed.
Results:
A total of 131 patients were divided into high (n = 99) and low (n = 32) s-iATP groups based on the optimal cutoff value of 68 ng/mL. s-iATP showed a weak positive correlation with CD4⁺ T-cell count (r = 0.24). ROC analysis identified s-iATP as the best predictor of 28-day mortality (AUC = 0.760). Patients in the low s-iATP group had higher 28-day mortality, in-hospital mortality, progression to septic shock, and development of MODS among those without MODS at admission. After adjustment for confounders, low s-iATP remained independently associated with increased 28-day mortality (HR = 2.53, 95% CI: 1.12-5.74, P = 0.026). The combined s-iATP and APACHE II model did not show a statistically significant improvement over APACHE II alone (AUC, 0.895 vs 0.859; DeLong P = 0.081).
Conclusion:
Low s-iATP levels within 24 hours of sepsis diagnosis were independently associated with increased 28-day mortality in adult ICU patients with sepsis. s-iATP may provide functional immune information complementary to conventional severity scores, but its incremental prognostic value requires further validation in larger prospective cohorts.
