High expression of CD3+T-lymphocytes in cerebrospinal fluid increases the risk of critical cerebral hemorrhage with systemic inflammatory response syndrome (SIRS) after surgery

IF 3.2 3区医学 Q2 MEDICAL LABORATORY TECHNOLOGY

Clinica Chimica Acta Pub Date : 2024-10-12 DOI:10.1016/j.cca.2024.119997

Chunying Zhu , Yingfu Zhang , Wei Li , Liang Yan , Xinjun Shan , Yongmei Hao

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引用次数: 0

Abstract

Objective

To assess the frequency of lymphocyte subsets and other laboratory indicators in paired cerebrospinal fluid (CSF) and peripheral blood (PB) samples from critically ill patients with intracerebral hemorrhage (ICH) who developed systemic inflammatory response syndrome (SIRS) following surgery.

Introduction

Neuroinflammation and systemic inflammatory responses significantly contribute to secondary brain injury following ICH. Post-surgery SIRS is known to worsen clinical outcomes in ICH patients; however, the immune response in the CSF and PB has not been fully characterized. Understanding immunological changes in ICH patients with SIRS could lead to improved clinical management and prognostic outcomes.

Methods

This study involved a retrospective analysis of data from patients with ICH who underwent surgery in the Neurological Intensive Care Unit (NICU) of Baoding No. 1 Hospital, Hebei Province, China, between January and July 2022. Patients were divided into SIRS and non-SIRS groups based on the clinical criteria. Demographic, clinical, and laboratory data, including lymphocyte subsets in CSF and PB, were collected and analyzed. This study compared lymphocyte subsets and other inflammatory markers between the SIRS and non-SIRS groups.

Results

Patients with SIRS demonstrated higher systolic blood pressure (SBP) at admission, worse 90-day prognoses, elevated inflammatory markers, increased levels of complement proteins C3 and C4, and lower levels of immunoglobulin G (IgG) compared to patients without SIRS. Between 3–6 days post-surgery, SIRS patients showed higher percentages of CD3+T cells, CD4+T cells, and CD4+/CD8+ ratios in the CSF than non-SIRS patients. CD3+T cell percentages in the CSF were consistently higher than those in the PB and were independent of PB levels. In contrast, CD3-CD16+CD56+ natural killer (NK) cell percentages were lower in patients with SIRS. No significant differences in PB lymphocyte subsets were found between the two groups. A high CSF CD3+T cell percentage (≥85.68 %) was identified as the strongest predictor of critical ICH with SIRS after surgery, with an appropriate use criterion (AUC) of 0.7742, sensitivity of 77.42 %, specificity of 76.19 %, and 95 % CI of 0.6655–0.8829 (P < 0.0001).

Conclusion

Elevated levels of CD3+T lymphocytes in CSF are strongly associated with an increased risk of severe cerebral hemorrhage and SIRS following surgery. These findings suggest that monitoring CSF immune markers, particularly CD3+T lymphocytes, could serve as valuable predictors for the development of SIRS in critically ill ICH patients and inform post-surgical treatment strategies.

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脑脊液中 CD3+T 淋巴细胞的高表达会增加手术后发生伴有全身炎症反应综合征（SIRS）的危重脑出血的风险。

研究目的评估手术后出现全身炎症反应综合征（SIRS）的脑内出血（ICH）重症患者配对脑脊液（CSF）和外周血（PB）样本中淋巴细胞亚群的频率及其他实验室指标：简介：神经炎症和全身炎症反应是造成 ICH 继发性脑损伤的重要原因。众所周知，手术后 SIRS 会恶化 ICH 患者的临床预后；然而，CSF 和 PB 中的免疫反应尚未完全定性。了解患有 SIRS 的 ICH 患者的免疫学变化可改善临床管理和预后结果：本研究对 2022 年 1 月至 7 月期间在河北省保定市第一医院神经重症监护室（NICU）接受手术治疗的 ICH 患者的数据进行了回顾性分析。根据临床标准将患者分为SIRS组和非SIRS组。研究收集并分析了人口统计学、临床和实验室数据，包括 CSF 和 PB 中的淋巴细胞亚群。该研究比较了 SIRS 组和非 SIRS 组的淋巴细胞亚群和其他炎症指标：结果：与非 SIRS 患者相比，SIRS 患者入院时收缩压（SBP）较高，90 天预后较差，炎症标志物升高，补体蛋白 C3 和 C4 水平升高，免疫球蛋白 G（IgG）水平较低。手术后 3-6 天内，SIRS 患者的脑脊液中 CD3+T 细胞、CD4+T 细胞的百分比和 CD4+/CD8+ 比率均高于非 SIRS 患者。CSF 中 CD3+T 细胞的百分比始终高于 PB 中的百分比，且与 PB 水平无关。相比之下，SIRS 患者的 CD3-CD16+CD56+ 自然杀伤（NK）细胞百分比较低。两组患者的 PB 淋巴细胞亚群无明显差异。高 CSF CD3+T 细胞百分比（≥85.68 %）被认为是术后危重 ICH 合并 SIRS 的最强预测指标，其适当使用标准（AUC）为 0.7742，敏感性为 77.42 %，特异性为 76.19 %，95 % CI 为 0.6655-0.8829（P 结论：CSF CD3+T 细胞百分比越高，术后危重 ICH 合并 SIRS 的可能性越大：CSF 中 CD3+T 淋巴细胞水平升高与手术后严重脑出血和 SIRS 风险增加密切相关。这些研究结果表明，监测 CSF 免疫标记物，尤其是 CD3+T 淋巴细胞，可作为重症 ICH 患者发生 SIRS 的重要预测指标，并为术后治疗策略提供依据。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinica Chimica Acta 医学-医学实验技术

CiteScore

10.10

自引率

2.00%

发文量

1268

审稿时长

23 days

期刊介绍： The Official Journal of the International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) Clinica Chimica Acta is a high-quality journal which publishes original Research Communications in the field of clinical chemistry and laboratory medicine, defined as the diagnostic application of chemistry, biochemistry, immunochemistry, biochemical aspects of hematology, toxicology, and molecular biology to the study of human disease in body fluids and cells. The objective of the journal is to publish novel information leading to a better understanding of biological mechanisms of human diseases, their prevention, diagnosis, and patient management. Reports of an applied clinical character are also welcome. Papers concerned with normal metabolic processes or with constituents of normal cells or body fluids, such as reports of experimental or clinical studies in animals, are only considered when they are clearly and directly relevant to human disease. Evaluation of commercial products have a low priority for publication, unless they are novel or represent a technological breakthrough. Studies dealing with effects of drugs and natural products and studies dealing with the redox status in various diseases are not within the journal''s scope. Development and evaluation of novel analytical methodologies where applicable to diagnostic clinical chemistry and laboratory medicine, including point-of-care testing, and topics on laboratory management and informatics will also be considered. Studies focused on emerging diagnostic technologies and (big) data analysis procedures including digitalization, mobile Health, and artificial Intelligence applied to Laboratory Medicine are also of interest.