Higher circulating neutrophil apoptosis in non-survivors with sepsis.

Abstract

Background: Unusual cell death in immune cells contributes to immunosuppression in sepsis. Neutrophils play a crucial role in fighting pathogens. However, the roles of apoptosis, pyroptosis, and neutrophil extracellular trap (NET) formation (NETosis) in neutrophils during sepsis remain unclear.

Methods: Patients admitted to the intensive care unit with sepsis were enrolled between August 2021 and July 2024. Apoptosis, pyroptosis, and NETosis in circulating neutrophils were measured on days 1 and 8. Finally, data from 43 patients were used for analysis.

Results: On day 8, the count and percentage of neutrophils dying primarily through apoptosis were significantly higher in non-survivors compared to survivors (9.7 vs. 2.0/μL; 7.2 vs. 3.4%, respectively). General Linear Model revealed significant differences in both the percentage (p = 0.035) and count (p = 0.008) of apoptosis-predominant neutrophil death on days 1 and 8 between survivors and non-survivors. The percentage and count of apoptosis-predominant neutrophils on day 8 were positively correlated with the APACHE II score on day 8 with correlation coefficients of 0.560 (p < 0.001) and 0.513 (p = 0.002), respectively. SOFA score was weakly positively correlated with the count of apoptosis-predominant neutrophils on days 1 and 8 with correlation coefficients of 0.347 (p = 0.023) and 0.375 (p = 0.029), respectively.

Conclusion: This study suggests that increased neutrophil death via apoptosis is associated with higher mortality rates in sepsis patients. Neutrophil apoptosis levels correlated with disease severity scores. Larger-scale studies are needed to confirm these findings.