RESUMEN
BACKGROUND: Immune suppression contributes to nosocomial infections (NIs) and poor prognosis in sepsis. Recent studies revealed that CD71+ erythroid cells had unappreciated immunosuppressive functions. This study aimed to investigate the values of CD71+ erythroid cells (CECs) in predicting NIs and prognosis among adult septic patients. The potential factors associated with the expansion of CECs were also explored. METHODS: In total, 112 septic patients and 32 critically ill controls were enrolled. The frequencies of CD71+ cells, CD71+CD235a+ cells, and CD45+ CECs were measured by flow cytometry. The associations between CECs and NIs and 30-day mortality were assessed by ROC curve analysis and Cox and competing-risk regression models. Factors associated with the frequency of CECs were identified by linear regression analysis. RESULTS: The percentage of CD71+ cells, CECs, and CD45+ CECs were higher in septic patients than critically ill controls. In septic patients, the percentages of CD71+ cells, CECs, and CD45+ CECs were associated with NI development, while CD71+ cells and CECs were independently associated with 30-day mortality. Linear regression analysis showed that the levels of interleukin (IL)-6 and interferon (IFN)-γ were positively associated with the frequencies of CD71+ cells, CECs, and CD45+ CECs, while IL-10 was negatively associated with them. Additionally, the levels of red blood cells (RBCs) were negatively associated with the percentage of CD45+ CECs. CONCLUSIONS: CECs were expanded in sepsis and can serve as independent predictors of the development of NI and 30-day mortality. Low levels of RBCs and high levels of IL-6 and IFN-γ may contribute to the expansion of CECs in sepsis. TRIAL REGISTRATION: ChiCTR, ChiCTR1900024887. Registered 2 August 2019, http://www.chictr.org.cn/showproj.aspx?proj=38645.
Asunto(s)
Infección Hospitalaria , Sepsis , Adulto , Enfermedad Crítica , Células Eritroides , Humanos , PronósticoRESUMEN
BACKGROUND: Providing supplemental oxygen is common in the management of critically ill patients, yet the optimal oxygen regimen remains unclear. OBJECTIVES: To explore the optimal range of PaO2 in critically ill patients. METHODS: This is a retrospective study conducted in the Medical Information Mart for Intensive Care III (MIMIC-III) database. The patients with a least 48 h of oxygen therapy were included. Nonlinear regression was used to analyze the association between PaO2 and mortality. We derived an optimal range of PaO2 and evaluated the association between the proportion of PaO2 measurements within this range and mortality. RESULTS: In total, 8401 patients were included in the study. A J-shaped relationship was observed between median PaO2 and hospital mortality. Compared with the reference group of 100-120 mmHg, patients with values of 80-100 mmHg and 120-140 mmHg had higher hospital mortality (adjusted odds ratio [aOR], 1.23; 95% CI, 1.05-1.43 and 1.29; 95%CI, 1.08-1.54, respectively). Similarly, mortality rates were significantly higher for PaO2 <80 mmHg and ≥140 mmHg (aOR, 1.97; 95%CI, 1.58-2.45 and 1.42; 95%CI, 1.19-1.69, respectively). Patients spent a greater proportion of time within 100-120 mmHg tended to have a lower mortality rate. CONCLUSION: Among critically ill patients, the relationship between median PaO2 and hospital mortality was J-shaped. The lowest rates of mortality was observed in those with PaO2 levels within 100 to 120 mmHg.