Immune Dysfunction is Associated with Readmission in Survivors of Sepsis Following Infected Pancreatic Necrosis.
Immune Dysfunction is Associated with Readmission in Survivors of Sepsis Following Infected Pancreatic Necrosis.
复制标题
免疫功能障碍与感染性胰腺坏死后败血症幸存者的再入院有关
DOI：
10.2147/jir.s321507
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发表时间：
2021
影响因子：
4.5
通讯作者：
Li W
中科院分区：
文献类型：
--
作者：
Yin J;Mao W;Xiao X;Yu X;Li B;Chen F;Lin J;Zhou J;Zhou J;Tong Z;Ke L;Li W
目的 免疫抑制在感染性胰腺坏死 (IPN) 患者中很常见，并且与发病率和死亡率相关。本研究旨在探讨免疫状态对 IPN 相关脓毒症患者出院后死亡率和再入院的影响。方法 在这项前瞻性观察研究中，纳入了需要入住 ICU 的符合条件的 IPN 相关脓毒症成年患者。在脓毒症诊断、ICU出院、出院以及出院后15、30、60天时测量单核细胞人类白细胞抗原DR（mHLA-DR）、调节性T细胞（Treg）和中性粒细胞CD88（nCD88）的表达。使用逻辑回归模型评估出院后 60 天内再次入院的潜在危险因素。结果共纳入53例患者，其中13例在住院期间死亡，1例出院后不久撤回同意。在幸存者中，在连续随访期间观察到免疫恢复的趋势，mHLA-DR表达增加证明了这一点。 16 名患者（41.03%）在出院后 60 天内再次入院。在多变量回归模型中，脓毒症诊断时的 APACHE II 评分 >9 和出院时的 mHLA-DR <14,591 AB/C 被发现是影响再入院的独立危险因素。结论 免疫抑制在 IPN 相关脓毒症患者中很常见，并且可持续至出院后两个月。出院时 mHLA-DR 水平受损与出院后两个月内再次入院有关。
Objective Immunosuppression is common in patients with infected pancreatic necrosis (IPN) and associated with morbidity and mortality. This study aimed to investigate the impact of immune status on mortality and readmission after hospital discharge in patients with IPN-related sepsis. Methods In this prospective observational study, eligible adult patients with IPN-related sepsis requiring ICU admission were included. Monocytic human leukocyte antigen DR (mHLA-DR), expression of regulatory T cells (Treg), and neutrophil CD88 (nCD88) were measured on the diagnosis of sepsis, ICU discharge, hospital discharge, and 15, 30, 60 days after hospital discharge. Logistic regression model was used to assess potential risk factors for readmission 60-days within the index discharge. Results A total of 53 patients were included, 13 died during hospitalization and one withdrew the consent soon after discharge. Among the survivors, a tendency of immune recovery was observed during the consecutive follow-ups, evidenced by the increased expression of mHLA-DR. Sixteen patients (41.03%) were readmitted within 60 days after the index discharge. In the multivariable regression model, APACHE II score when sepsis was diagnosed >9 and mHLA-DR at discharged <14,591 AB/C were found to be independent risk factors affecting readmission. Conclusion Immunosuppression is common in patients with IPN-related sepsis and can persist until two months after discharge. The compromised mHLA-DR level at discharge was associated with readmission within two months after discharge.