八旬及高龄患者脓毒症后淋巴细胞亚群的动态变化

Journal of intensive medicine Pub Date : 2025-10-01 DOI:10.1016/j.jointm.2025.04.002

Jiahui Zhang , Wei Cheng , Dongkai Li , Ran Guo , Guoyu Zhao , Na Cui

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引用次数: 0

摘要

脓毒症被定义为由宿主对感染反应失调引起的危及生命的器官功能障碍。本研究旨在探讨八旬及老年患者脓毒症后外周血淋巴细胞亚群的早期动态变化，以及这些变化是否与28天死亡率有关。方法对2017年3月至2023年1月期间连续入住重症监护病房（ICU）的3601例患者进行前瞻性队列研究。脓毒症患者和非脓毒症患者在入院、第3天和第7天采集外周血样本。流式细胞术检测淋巴细胞亚群。28天死亡率采用Kaplan-Meier分析确定，Cox回归确定预后因素。结果所有入组患者分为3组：成人（18-64岁）、老年（65-79岁）和老年（≥80岁）。脓毒症导致80岁以上患者淋巴细胞数量减少（中位数=0.653 [IQR: 0.500-1.038] vs中位数=0.840 [IQR: 0.579-1.142] × 109/L， P=0.043）和CD3+ t细胞计数减少（中位数=0.461 [IQR: 0.312-0.759] vs中位数=0.590 [IQR: 0.417-0.789] × 109/L， P=0.021）。Kaplan-Meier生存曲线显示，在老年组（P [log-rank检验]<； 0.001）和老年组（P [log-rank检验]=0.02）中，CD3+ t细胞在第3天和第7天未恢复的患者死亡率最高，恢复较晚的患者次之，早期恢复组死亡率最低。多因素Cox回归分析显示，年龄（风险比[HR]=1.217, 95%可信区间[CI]: 1.050 ~ 1.410， P=0.009）和CD3+ t细胞计数（HR=0.999, 95% CI: 0.999 ~ 1.000, P < 0.001）是脓毒症患者28天死亡率的独立危险因素。结论脓毒症导致80岁以上患者淋巴细胞和CD3+ t细胞计数减少。脓毒症后第3天和第7天CD3+ t细胞计数持续下降与老年和八旬患者较高的死亡率相关。中国临床试验注册中心标识：ChiCTR-ROC-17010750。

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Dynamic alterations of lymphocyte subsets following sepsis in octogenarian and elder patients

Background

Sepsis is defined as a life-threatening organ dysfunction caused by dysregulated host responses to infections. This study aimed to investigate the early and dynamic changes in peripheral lymphocyte subsets following sepsis in octogenarian and elder patients and whether these changes were related to 28-day mortality.

Methods

A prospective cohort study of 3601 consecutive patients admitted to the intensive care unit (ICU) was performed between March 2017 and January 2023. Peripheral blood samples were collected on admission, Day 3, and Day 7 for patients with sepsis and on enrollment for patients without sepsis. Lymphocyte subsets were detected by flow cytometry. The 28-day mortality was determined using Kaplan–Meier analysis, while Cox regression identified prognostic factors.

Results

All enrolled patients were divided into three groups: adult (18–64 years), elder (65–79 years), and octogenarian (≥80 years). Sepsis induced a numerical reduction in lymphocytes (median=0.653 [IQR: 0.500–1.038] vs. median=0.840 [IQR: 0.579–1.142] × 10⁹/L, P=0.043) and CD3⁺ T-cell counts (median=0.461 [IQR: 0.312–0.759] vs. median=0.590 [IQR: 0.417–0.789] × 10⁹/L, P=0.021) in octogenarian patients. Kaplan–Meier survival curves showed that in the elder (P [log-rank test] < 0.001) and octogenarian (P [log-rank test]=0.02) groups, patients with CD3⁺ T-cell nonrecovery on Day 3 and Day 7 had the highest mortality, followed by those with late recovery, and the lowest mortality was observed in the early recovery group. Multivariate Cox regression analysis demonstrated that age (hazard ratio [HR]=1.217, 95% confidence interval [CI]: 1.050 to 1.410, P=0.009) and CD3⁺T-cell counts (HR=0.999, 95% CI: 0.999 to 1.000, P < 0.001) were independent risk factors associated with 28-day mortality in patients with sepsis.

Conclusions

Sepsis induced a numerical reduction in lymphocytes and CD3⁺ T-cell counts in octogenarian patients (≥80 years). The persistent decrease of CD3⁺ T-cell counts on Day 3 and Day 7 following sepsis was associated with higher mortality in elder and octogenarian patients.

Trial registration Chinese Clinical Trial Registry identifier: ChiCTR-ROC-17010750.

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