Peripheral T-lymphocyte and natural killer cell population imbalance is associated with septic encephalopathy in patients with severe sepsis

Abstract

Abstract. Septic encephalopathy (SE) is a diffuse cerebral dysfunction resulting from a systemic inflammatory response, and is associated with an increased risk of mortality. The pathogenesis of SE is complex and multifactorial, but unregulated immune imbalance may be an important factor. The current retrospective study examined the clinical data of 86 patients with severe sepsis who were admitted to the Intensive Care Unit at Zhongshan Hospital, Xiamen University (Xiamen, China) from January, 2014 to January, 2015. The patients were assigned to SE and non-SE patient groups according to the presence or absence of SE. The proportion of T-lymphocyte subsets and natural killer (NK) cells in the immune cell population, representing the function of the immune system, were analyzed for their association with SE and compared with other clinical predictors and biomarkers. + T-lymphocytes were demonstrated to be independently associated with SE (respectively, P=0. 012 and OR, 4.763; P=0.005 and OR, 0.810). An area under the curve analysis of a receiver operating characteristic curve of the two indicators revealed that these were equally powerful measures in prediction of SE (Z=1.247, P>0.05). The present results confirm that SE leads to higher mortality in patients with severe sepsis, and demonstrate that immune imbalance is important in the development of SE. The proportion of CD4 + T-lymphocytes present were revealed in the current study to be a powerful predictor of SE in patients with severe sepsis.

Seasonality in the adverse outcomes in weight loss surgeries

“…Our study reveals the significance of seasonality in predicting adverse postoperative outcomes in bariatric surgeries and thus provides evidence to help the decision making about the timing for these elective surgeries. For patients with elevated risks for DVT complications (e.g., chronic heart failure, long hours of physical inactivity, history of multiple pregnancies, or rheumatoid arthritis [27,40]) and sepsis (e.g., older age, immune system impairment, chronic or serious illness [41,42]), such precautionary awareness of the possible seasonality factor could be particularly important. On the other hand, because the crude rate for DVT was only .16%, the clinical implication of those statistically significant ORs we estimated might be limited.…”

Sepsis-associated encephalopathy: a vicious cycle of immunosuppression

“…Failure to maintain homeostasis between Th1 and Th2 cells might be a major indicator of immune system dysfunction under septic conditions [89]. Depletion of peripheral T lymphocytes is independently associated with the development of SAE, as reported by Lu and colleagues [92]. Similarly, the types of T cells and their polarization status accounts for sepsis-induced brain injury and should be taken into consideration for effective treatments [93].…”

Increased percentage of PD-L1+ natural killer cells predicts poor prognosis in sepsis patients: a prospective observational cohort study

“…On the other hand, Boomer et al [19] and Holub et al [20] had reported decreased number of NK cells in the blood of patients at 24 h after the onset of sepsis. This phenomenon was thought to be related to the increased incidence of secondary infection [21] and sepsis encephalopathy [22]. The multi-faceted effects of NK cells have led to contradictory outcomes in patients with sepsis.…”

“…Twentyeight patients had nosocomial infections, and 41 patients had septic shock. APACHE II scores (22 [15][16][17][18][19][20][21][22][23][24][25][26] vs.15 [10][11][12][13][14][15][16][17][18][19][20][21][22], p = 0.003), SOFA scores (9 (6-13) vs. 6 (4-9), p < 0.001), lactate level (2.5 (1.7-4.0) mmol/L vs. 1.5 (1.1-2.5) mmol/L, p = 0.002), and positive rate of bloodstream infection (16.7% vs. 4.8%, p = 0.038) were significantly higher in the non-survivors than the survivors. However, the Glasgow Coma Scale (GCS) scores showed the opposite trend between the two groups (7 (6)(7)(8)(9)(10)(11)(12)(13)(14) vs.14 (8)(9)(10)(11)(12)(13)(14)(15), p = 0.007).…”