Association of exposure to environmental heavy metals with markers of sepsis susceptibility: a population-based study from NHANES.

IF 2.1 4区医学 Q4 TOXICOLOGY

Inhalation Toxicology Pub Date : 2026-10-01 Epub Date: 2026-06-19 DOI:10.1080/08958378.2026.2687782

Duo Li, Zhu Yue, Genshen Zhen

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引用次数: 0

Abstract

Background: Sepsis is a life-threatening syndrome of immune dysregulation; preexisting lymphopenia and an elevated neutrophil-to-lymphocyte ratio (NLR) heighten host susceptibility. Chronic low-dose exposure to lead (Pb), cadmium (Cd), and mercury (Hg) is immunotoxic, but its association with these pre-sepsis markers in the general population remains unclear.

Methods: We analyzed 12,580 adults from NHANES 2011-2018. Outcomes were lymphopenia (absolute lymphocyte count <1.0 × 10⁹/L) and high NLR (top quartile). Survey-weighted logistic and Weighted Quantile Sum (WQS) regressions evaluated individual and joint mixture effects. Restricted cubic splines modeled dose-response relationships. Continuous exposure models were also constructed to minimize information loss.

Results: Fully adjusted models showed higher quartiles of Pb, Cd, and Hg were each associated with greater odds of lymphopenia and high NLR. Comparing highest to lowest quartiles, ORs for lymphopenia were 1.85 (95% CI 1.42-2.41) for Pb, 1.66 (95% CI 1.28-2.15) for Cd, and 1.52 (95% CI 1.15-2.01) for Hg. Continuous models confirmed that each log2-fold increase in blood metals was associated with significantly reduced absolute lymphocyte counts and elevated NLR (all p < 0.05). The WQS index was positively associated with lymphopenia (OR 1.63) and high NLR (OR 1.48).

Conclusion: In a nationally representative sample, chronic low-level exposure to Pb, Cd, and Hg was independently associated with an immune profile linked to sepsis susceptibility, suggesting environmental metal reduction as a potential population-level strategy to reduce sepsis risk.

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暴露于环境重金属与败血症易感性标志物的关联：来自NHANES的基于人群的研究。

背景：脓毒症是一种危及生命的免疫失调综合征；先前存在的淋巴细胞减少和中性粒细胞与淋巴细胞比率（NLR）升高会增加宿主的易感性。慢性低剂量暴露于铅（Pb）、镉（Cd）和汞（Hg）具有免疫毒性，但其与普通人群中这些败血症前标志物的关系尚不清楚。方法：我们分析了来自NHANES 2011-2018的12580名成年人。结果是淋巴细胞减少（绝对淋巴细胞计数9/L）和高NLR（最高四分位数）。调查加权logistic和加权分位数和（WQS）回归评估个体和联合混合效应。限制三次样条模拟剂量-反应关系。为了最大限度地减少信息损失，还构建了连续暴露模型。结果：完全调整后的模型显示，高四分位数的铅、镉和汞均与淋巴细胞减少和高NLR的可能性相关。比较最高和最低四分位数，铅的淋巴细胞减少的or值为1.85 (95% CI 1.42-2.41)，镉的or值为1.66 (95% CI 1.28-2.15)，汞的or值为1.52 （95% CI 1.15-2.01）。连续模型证实，血液中金属每增加log2倍，淋巴细胞绝对计数显著减少，NLR升高（均p）。在一个具有全国代表性的样本中，慢性低水平暴露于Pb、Cd和Hg与与败血症易感性相关的免疫谱独立相关，表明环境金属减少是降低败血症风险的潜在人群水平策略。

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来源期刊

Inhalation Toxicology 医学-毒理学

CiteScore

4.10

自引率

4.80%

发文量

审稿时长

6-12 weeks

期刊介绍： Inhalation Toxicology is a peer-reviewed publication providing a key forum for the latest accomplishments and advancements in concepts, approaches, and procedures presently being used to evaluate the health risk associated with airborne chemicals. The journal publishes original research, reviews, symposia, and workshop topics involving the respiratory system’s functions in health and disease, the pathogenesis and mechanism of injury, the extrapolation of animal data to humans, the effects of inhaled substances on extra-pulmonary systems, as well as reliable and innovative models for predicting human disease.