PMID- 30114952
OWN - NLM
STAT- MEDLINE
DCOM- 20181211
LR  - 20181211
IS  - 2058-7384 (Electronic)
IS  - 0394-6320 (Print)
IS  - 0394-6320 (Linking)
VI  - 32
DP  - 2018 Jan-Dec
TI  - Analysis of peripheral blood lymphocyte subsets in critical patients at ICU 
      admission: A preliminary investigation of their role in the prediction of sepsis 
      during ICU stay.
PG  - 2058738418792310
LID - 10.1177/2058738418792310 [doi]
LID - 2058738418792310
AB  - A better knowledge of factors predicting the development of sepsis in patients 
      hospitalized in intensive care unit (ICU) might help deploy more targeted 
      preventive and therapeutic strategies. In addition to the known clinical and 
      demographic predictors of septic syndromes, in this study, we investigated 
      whether measuring T and B lymphocyte subsets upon admission in the ICU may help 
      individualize the prediction of ensuing sepsis during ICU stay. Between May 2015 
      and December 2016, we performed a prospective cohort study evaluating peripheral 
      blood lymphocyte T-CD4+ (T-helper cells), T-CD8+ (cytotoxic T-cells), T-CD56 + 
      (natural killer cells), and T-CD19+ (B-lymphocytes), using flow cytometry on 
      blood samples collected 2 days after admission in the ICU. We enrolled 176 
      patients, 65.3% males, with mean age of 61.1 +/- 15.4 years. At univariate 
      analyses, higher percentages of CD19 B-cells were significantly associated with 
      ensuing sepsis (20.5% (15.7-27.7)% vs 16.9% (11.3-22)%, P = 0.0001), whereas 
      median interquartile range (IQR) proportions of CD4 T-cells (41.2% (33.4-50.6)% 
      vs 40% (35-47)%, P = 0.5), CD8 T-cells (21.1% (15.8-28.2)% vs 19.6% (14.6-25.1)%, 
      P = 0.2) and CD56 T-cells (1.7% (0.9-3.1)% vs 1.45% (0.7-2.3)%, P = 0.4) did not 
      reveal any significant association. An unexpected, highly significant inverse 
      correlation of CD8 T-cells and CD19 B-cells proportions, however, was observed, 
      suggesting that patients with lower CD19 and higher CD8 proportions might be 
      somehow protected from ensuing sepsis. We therefore studied the ability of the 
      CD8/CD19 ratio to predict ensuing sepsis in our sample. In final models of 
      multivariate logistic regression, the following independent associations were 
      found: previous antibiotic exposure (odds ratio (OR): 3.8 (95% confidence 
      interval (CI): 1.35-10.87), P = 0.01), isolation of at least one multi-drug 
      resistant organism at any time during ICU stay (OR: 8.4 (95% CI: 3.47-20.6), 
      P < 0.0001), decreasing age (OR: 0.9 (95% CI: 0.93-0.99), P = 0.02) and a 
      CD8/CD19 ratio >2.2 (OR: 10.3 (95% CI: 1.91-55.36), P = 0.007). Our data provide 
      preliminary evidence that immune characterization of critically ill patients on 
      ICU admission may help personalize the prediction of ensuing sepsis during their 
      ICU stay. Further polycentric evaluation of the true potential of this new tool 
      is warranted.
FAU - Frattari, Antonella
AU  - Frattari A
AD  - 1 Unit of Intensive Care, Pescara General Hospital, Pescara, Italy.
FAU - Polilli, Ennio
AU  - Polilli E
AD  - 2 Unit of Clinical Pathology, Pescara General Hospital, Pescara, Italy.
FAU - Primiterra, Vanessa
AU  - Primiterra V
AD  - 2 Unit of Clinical Pathology, Pescara General Hospital, Pescara, Italy.
FAU - Savini, Vincenzo
AU  - Savini V
AD  - 3 Unit of Clinical Microbiology, Pescara General Hospital, Pescara, Italy.
FAU - Ursini, Tamara
AU  - Ursini T
AD  - 4 Unit of Infectious Diseases, Pescara General Hospital, Pescara, Italy.
FAU - Di Iorio, Giancarlo
AU  - Di Iorio G
AD  - 2 Unit of Clinical Pathology, Pescara General Hospital, Pescara, Italy.
FAU - Parruti, Giustino
AU  - Parruti G
AD  - 4 Unit of Infectious Diseases, Pescara General Hospital, Pescara, Italy.
LA  - eng
PT  - Journal Article
PL  - England
TA  - Int J Immunopathol Pharmacol
JT  - International journal of immunopathology and pharmacology
JID - 8911335
RN  - 0 (Anti-Bacterial Agents)
RN  - 0 (Biomarkers)
SB  - IM
MH  - APACHE
MH  - Age Factors
MH  - Aged
MH  - Anti-Bacterial Agents/adverse effects
MH  - B-Lymphocyte Subsets/*immunology/microbiology
MH  - Biomarkers/blood
MH  - Female
MH  - Flow Cytometry
MH  - Host-Pathogen Interactions
MH  - Humans
MH  - Immunophenotyping/methods
MH  - *Intensive Care Units
MH  - Lymphocyte Count
MH  - Male
MH  - Middle Aged
MH  - *Patient Admission
MH  - Phenotype
MH  - Predictive Value of Tests
MH  - Preliminary Data
MH  - Prognosis
MH  - Prospective Studies
MH  - Risk Factors
MH  - Sepsis/blood/diagnosis/*immunology/microbiology
MH  - Sex Factors
MH  - T-Lymphocyte Subsets/*immunology/microbiology
PMC - PMC6100127
OTO - NOTNLM
OT  - ICU
OT  - critically ill patients
OT  - immune-protective phenotype
OT  - lymphocyte subsets
OT  - sepsis
COIS- Declaration of conflicting interests: The author(s) declared no potential 
      conflicts of interest with respect to the research, authorship, and/or 
      publication of this article.
EDAT- 2018/08/18 06:00
MHDA- 2018/12/12 06:00
PMCR- 2018/08/17
CRDT- 2018/08/18 06:00
PHST- 2018/08/18 06:00 [entrez]
PHST- 2018/08/18 06:00 [pubmed]
PHST- 2018/12/12 06:00 [medline]
PHST- 2018/08/17 00:00 [pmc-release]
AID - 10.1177_2058738418792310 [pii]
AID - 10.1177/2058738418792310 [doi]
PST - ppublish
SO  - Int J Immunopathol Pharmacol. 2018 Jan-Dec;32:2058738418792310. doi: 
      10.1177/2058738418792310.