The Prediction For IC Diagnosis And Prognosis:the Usefulness Of Lymphocyte Subtyping

ObjectiveTo assess the predictive value of lymphocyte subtyping for Invasive candidiasis(IC)diagnosis and prognosis in a cohort of non-neutropenic sepsis patients.MethodsA prospective observational cohort study was performed at the Peking Union Medical College Hospital(PUMCH),sepsis patients admitted to the department of intensive care medicine from January 2017 to November 2019 were selected.Diagnosis of IC was according to the IC diagnostic criteria based on 2008 European Organization of the Research and Treatment of Cancer/Mycoses Study Group(EORTC/MSG)definition.Clinical data and microbiological specimens were collected,peripheral blood samples were detected within 24 hours of the onset of sepsis.Results1.377 patients were enrolled,the median score of acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ)was 17,the median score of sequential organ failure score(SOFA)was 11,the 28-day mortality was 27.6%.34(9.02%)patients were in the IC group,the median APACHE Ⅱ score(19 vs 16,p=0.035)and 28-day mortality(44.1%vs 25.8%,p=0.024)were significantly higher in IC group compared with non-IC group.2.In terms of diagnosis,CD8+T-cell count≤177cells/μl,CD28+CD8+T-cell count≤81cells/μl and 1,3-β-D-glucan(BDG)≥88.2pg/ml were closely correlated with the diagnosis of IC.CD28+CD8+T-cell counts had larger AUC(AUC 0.892,95%CI 0.856-0.921)for IC diagnosis than that of CD8+T-cell count(AUC 0.793,95%CI 0.749-0.833;p<0.0001)and BDG(AUC 0.761,95%CI 0.715-0.803;p=0.0004),the sensitivity and specificity for IC diagnosis were 94.12%,81.34%;100%,62.39%and 88.24%,63.56%respectively.3.To assess the discrimination of prognosis,we applied ROC analysis with the immune parameters that differed significantly between survivors and nonsurvivors in IC patients according to 28-day mortality.The CD8+and CD28+CD8+ T-cell counts had great predictive value in IC prognosis.The cutoff values of CD8+ and CD28+CD8+T-cell counts to predict 28-day mortality were 139 cells/μl and 52cells/μl.Multivariate logistic regression analysis identified CD8+T-cell count≤139cells/μl(OR 7.463,95%CI 1.300-42.831;p=0.024)and CD28+CD8+T-cell counts≤52cells/μl(OR 57.494,95%CI 3.986-829.359;p=0.003)as independent risk factors for higher mortality of IC patients.Kaplan-Meier survival analysis provided evidence that CD8+T-cell count≤139cells/μl(log-rank test;p=0.0159)and CD28+CD8+T-cell count≤52cells/μl(log-rank test,p=0.0001)were associated with higher mortality within 28 days of enrollment.ConclusionsCD8+T-cell count and CD28+CD8+T-cell count were significantly decreased early time after the onset of IC infection in non-neutropenic sepsis patients,which was closely related to the diagnosis and prognosis of IC.CD8+ T-cell or CD28+CD8+T-cell count may be used as effective indicators of IC diagnosis and prognosis prediction.