Frontiers in Immunology (Sep 2022)

Immunological risk factors for sepsis-associated delirium and mortality in ICU patients

  • Wen Lei,
  • Wen Lei,
  • Wen Lei,
  • Zhiyao Ren,
  • Zhiyao Ren,
  • Zhiyao Ren,
  • Zhiyao Ren,
  • Jun Su,
  • Jun Su,
  • Xinglong Zheng,
  • Xinglong Zheng,
  • Lijuan Gao,
  • Lijuan Gao,
  • Lijuan Gao,
  • Yudai Xu,
  • Yudai Xu,
  • Yudai Xu,
  • Jieping Deng,
  • Jieping Deng,
  • Jieping Deng,
  • Chanchan Xiao,
  • Chanchan Xiao,
  • Chanchan Xiao,
  • Shuai Sheng,
  • Yu Cheng,
  • Yu Cheng,
  • Tianshun Ma,
  • Tianshun Ma,
  • Yu Liu,
  • Pengcheng Wang,
  • Pengcheng Wang,
  • Pengcheng Wang,
  • Oscar Junhong Luo,
  • Oscar Junhong Luo,
  • Guobing Chen,
  • Guobing Chen,
  • Guobing Chen,
  • Guobing Chen,
  • Zhigang Wang,
  • Zhigang Wang

DOI
https://doi.org/10.3389/fimmu.2022.940779
Journal volume & issue
Vol. 13

Abstract

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BackgroundA major challenge in intervention of critical patients, especially sepsis-associated delirium (SAD) intervention, is the lack of predictive risk factors. As sepsis and SAD are heavily entangled with inflammatory and immunological processes, to identify the risk factors of SAD and mortality in the intensive care unit (ICU) and determine the underlying molecular mechanisms, the peripheral immune profiles of patients in the ICU were characterized.MethodsThis study contains a cohort of 52 critical patients who were admitted to the ICU of the First Affiliated Hospital of Jinan University. Comorbidity, including sepsis and SAD, of this cohort was diagnosed and recorded. Furthermore, peripheral blood samples were collected on days 1, 3, and 5 of admission for peripheral immune profiling with blood routine examination, flow cytometry, ELISA, RNA-seq, and qPCR.ResultsThe patients with SAD had higher mortality during ICU admission and within 28 days of discharge. Compared with survivors, nonsurvivors had higher neutrophilic granulocyte percentage, higher CRP concentration, lower monocyte count, lower monocyte percentage, lower C3 complement level, higher CD14loCD16+ monocytes percentage, and higher levels of IL-6 and TNFα. The CD14hiCD16- monocyte percentage manifested favorable prediction values for the occurrence of SAD. Differentially expressed genes between the nonsurvival and survival groups were mainly associated with immune response and metabolism process. The longitudinal expression pattern of SLC2A1 and STIMATE were different between nonsurvivors and survivors, which were validated by qPCR.ConclusionsNonsurvival critical patients have a distinct immune profile when compared with survival patients. CD14hiCD16- monocyte prevalence and expression levels of SLC2A1 and STIMATE may be predictors of SAD and 28-day mortality in ICU patients.

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