BACKGROUND & AIMS:
PURPOSE:Critical illness results in derangements of all components of the immune response. Nonetheless, most of the efforts evaluating immune status in critically ill patients have been done in the field of sepsis. Here we have evaluated the immunity status at intensive care unit (ICU) admission in a cohort of nonseptic critically ill patients and its influence on their outcome.
MATERIAL AND METHODS:Ninety patients 18 years and older admitted to our ICU were studied for levels of immunoglobulin (Ig) G, IgM, IgA, CD3(+)CD4(+) T cells, CD3(+)CD8(+) T cells, B cells, natural killer (NK) cells, and C3 and C4 complement factors in peripheral blood in the next 24 hours after admission to the ICU. Patients with infection, sepsis, immunodeficiency, or concomitant immunosuppressive therapy were excluded.
RESULTS:Levels of IgM, CD3(+) T cells, CD4(+) T cells, CD8(+) T cells, and B lymphocytes correlated inversely with age. In turn, levels of CD3(+) T cells, CD4(+) T cells, CD8(+) T cells, and C3 factor of the complement system correlated inversely with Acute Physiology and Chronic Health Evaluation II score. Multivariate Cox regression analysis censored at 28 days evidenced that levels of IgM played a protective role, whereas levels of NK cells behaved as a risk factor for mortality. Kaplan-Meier curves showed a cutoff of 58 mg/dL for IgM and 140 cells/mm(3) for NK cells.
CONCLUSIONS:In conclusion, our results demonstrate that IgM plays a protective role in critically ill patients with no sepsis, whereas NK cell counts seem to play a deleterious one. Aging and severity at admission affect levels of key factors of the immune system in the blood of these patients.
背景与目标:
目的:严重疾病会导致免疫反应的所有成分发生紊乱。尽管如此,评估重症患者免疫状况的大多数努力都是在败血症领域中进行的。在这里,我们评估了一群非败血症危重患者的重症监护病房(ICU)入院时的免疫状况及其对他们结局的影响。
材料和方法:对90例18岁及18岁以上的重症监护病房(ICU)的患者进行了免疫球蛋白(Ig)G,IgM,IgA,CD3()CD4()T细胞,CD3()CD8(T),B细胞,进入ICU后的24小时内,外周血中的自然杀伤(NK)细胞以及C3和C4补体因子。排除有感染,败血症,免疫缺陷或同时进行免疫抑制治疗的患者。
结果:IgM,CD3()T细胞,CD4()T细胞,CD8()T细胞和B淋巴细胞的水平与年龄呈负相关。反过来,补体系统的CD3()T细胞,CD4()T细胞,CD8()T细胞和C3因子的水平与急性生理学和慢性健康评估II得分成反比。在第28天进行的多变量Cox回归分析显示,IgM的水平起保护作用,而NK细胞的水平则是造成死亡的危险因素。 Kaplan-Meier曲线显示IgM的截止值为58 mg / dL,NK细胞的截止值为140 cells / mm(3)。
结论:总之,我们的结果表明,IgM在没有败血症的危重患者中起保护作用,而NK细胞计数似乎起有害作用。入院时的年龄和严重程度会影响这些患者血液中免疫系统关键因素的水平。