Study On Correlation Between The Pediatric Critical Illness Score In Children And Immunosunppression Of γδT Cells In Children With Sepsis

Objective:To analyse the correlation and clinical significance between the Paediatric Critical Case Score（PCIS）andγδT cells,NK cells,monocytes and their expression of CD69 in patients with sepsis.Methods:Thirty-three children with sepsis admitted to the Department of Pediatric Medicine,Minda Hospital,Hubei Minzu University,from June 1 to December 31,2021,and 23 children with non-sepsis during the same period were selected as the controls.2 ml of peripheral blood was collected from children in the sepsis group（24 h of admission,7 d）and the non-sepsis group.General clinical information was collected,a paediatric critical case score was completed within 24 h of admission to the sepsis group,and the number ofγδT cells,NK cells and monocytes in peripheral blood and their expression of CD69 were measured by flow cytometry.To compare the correlation between the paediatric critical case score and the number ofγδT cells,NK cells and monocytes and the number of CD69 they express in children in the sepsis group.Results:1.There were 33 children with sepsis in this study,19（57.60%）males and 14（42.40%）females,aged between1 month and 144 months,with a median age of 21 months and a median and interquartile weight of 12.50（7.70）Kg.There were 23 non-septic children,11（47.83%）males and 12（52.17%）females,aged between 1-113 months,with a median age of 15months and a median and interquartile weight of 11（7.00）kg.The differences in gender,age and weight between the two groups were not statistically significant（p>0.05）.Clinical features analyzed were fever 90.10%（30/33）,increased respiration 93.90%（31/33）,poor mental health 63.60%（21/33）,poor diet 36.40%（12/33）;cough 72.73%（24/33）,coughing sputum 48.50%（16/33）,wet rales and croup in the lungs 33.30%（11/33）,vomiting 48.50%（16/33）,diarrhoea 21.20%（7/33）,abdominal pain 9.09%（3/33）,blood in stool 3.03%（1/33）,impaired confusion 12.10%（4/33）,convulsions3.03%（1/33）,other（conjunctival congestion）3.03%（1/33）.Infection site analysis:respiratory system infections accounted for 75.80%（25/33）,digestive system infections accounted for 6.10%（2/33）,including 1 case of simultaneous digestive and neurological system infections.Infections of the nervous system alone accounted for6.10%（2/33）,infections of the urinary system accounted for 6.10%（2/33）and infections of other sites（1 case of lymph node infection and 1 case of pancreatitis）accounted for 6%（2/33）.In this study,there were 7 cases of mixed infections and 5cases of simple infections in the pathogenic testing of children in the sepsis group.There were 4 cases of Haemophilus influenzae infection,3 cases of Streptococcus pneumoniae infection,3 cases of influenza B virus infection,3 cases of respiratory syncytial virus infection,2 cases of Mycoplasma pneumoniae infection,and 1 case each of Salmonella cholerae,parapneumovirus,rhinovirus,parainfluenza virus,herpesvirus and Escherichia coli infection.The sepsis group had a higher body temperature of 39.40（0.90）°C than the non-sepsis group at 36.70（4.50）°C,a statistically significant difference（P=0.000）.There was a statistically significant difference in the increased respiration in the sepsis group compared to the non-sepsis group（P=0.038）;there was no statistically significant difference in the increased heart rate of the children in the sepsis group compared to the non-sepsis group（P=0.598）.2.Neutrophils 4.51（7.88）×10~9/L in the sepsis group were significantly higher than neutrophils 2.76（2.51）×10~9/L in the non-sepsis group,with a significant difference（P=0.027）;monocytes 0.87（1.29）×10~9/L in the sepsis group were higher than monocytes 0.65（0.28）×10~9/L in the non-sepsis group,with a significant difference（P=0.004）.CRP26.00（75.94）mg/L in the sepsis group was higher than CRP 0.70（4.50）mg/L in the non-sepsis group,with a significant difference（P=0.000）,PCT 0.67（0.94）ng/m L in the sepsis group was higher than PCT 0.39（0.22）ng/m L in the non-sepsis group,with a significant difference significant（P=0.016）.D-dimer 1.00（1.00）ug/L in the sepsis group was higher than D-dimer 0.70（0.50）ug/L in the non-sepsis group,with a significant difference（P=0.042）;lactate dehydrogenase 325.00（186.00）U/L in the sepsis group was higher than lactate dehydrogenase 247（88）U/L in the non-sepsis group,with a significant difference（P=0.035）.Red blood cells（4.18±0.77）×10¹²/L in the sepsis group were significantly lower than Red blood cells（4.49±0.12）×10¹²/L in the non-sepsis group,with a significant difference（P=0.024）.ALT 13.00（21.00）U/L in the sepsis group was significantly lower than ALT 18.00（22.00）U/L in the non-sepsis group,with a significant difference（P=0.030）.The differences in WBC,lymphocytes,haemoglobin,platelets,glutamate transaminase and albumin were not statistically significant.3.There were statistically significant differences between the non-sepsis,early sepsis and recovery sepsis groups in terms ofγδT cells,NK cells,monocytes and the three groups expressing CD69 overall（P=0.000,P=0.000;P=0.000,P=0.001,P=0.005,P=0.001）.TheγδT cell expression CD69 3.46（2.34）in the early sepsis group was higher than theγδT cell expression CD69 2.10（1.70）in the recovery sepsis group’s,and the difference was statistically significant（H=19.485,P=0.007）,but the differences inγδT cell,NK cell,monocyte,NK cell and monocyte expression CD69with the two groups were not statistically significant.The levels ofγδT cells,NK cells,monocytes and respectively CD69 expression in the early sepsis group were statistically significantly higher than in the non-sepsis group’s（P=0.000,P=0.000,P=0.000,P=0.003,P=0.004,P=0.000）.4.There was no statistically significant correlation coefficient between PCIS and the clinical data.PCIS had a statistically significant correlation coefficient with NK cells（P=0.016）and a positive correlation（r=0.417）;PCIS had a statistically significant correlation coefficient with NK cells expressing CD69 and monocytes expressing CD69（P=0.005,P=0.043）with a negative correlation（r=-0.477,r=-0.355）;PCIS had no statistically significant correlation coefficients withγδT cells,monocytes andγδT cells expressing CD69.Conclusion:（1）The correlation between pediatric critical case scores andγδT cells andγδT cells expressing CD69 is not yet available and needs further study.γδT cells andγδT cells expressing CD69have some value in the diagnosis and differential diagnosis of childhood sepsis,and dynamic monitoring of changes in peripheral bloodγδT cells expressing CD69 has some value in monitoring changes in sepsis.（2）The score of pediatric critical cases was negatively correlated with monocyte expression CD69,and the correlation with monocytes needs further study.The more severe the child’s condition,the higher the monocyte expression CD69,and monocyte expression CD69 can dynamically reflect the severity of the disease at a certain level;the detection of monocytes and their expression CD69 is valuable in the diagnosis and differential diagnosis of childhood sepsis.（3）NK cells and their expression of CD69 may reflect the degree of sepsis in children to some extent;they are valuable in the diagnosis and differential diagnosis of sepsis in children.