Combination of NK and Other Immune Markers at Early Phase Stratify the Risk of Sepsis Patients: A Retrospective Study

Zihan Hu; Danjiang Dong; Fei Peng; Xing Zhou; Qin Sun; Hui Chen; Wei Chang; Qin Gu; Jianfeng Xie; Yi Yang

doi:10.2147/JIR.S426828

Combination of NK and Other Immune Markers at Early Phase Stratify the Risk of Sepsis Patients: A Retrospective Study

J Inflamm Res. 2023 Oct 18:16:4725-4732. doi: 10.2147/JIR.S426828. eCollection 2023.

Authors

Zihan Hu^#¹, Danjiang Dong^#², Fei Peng^#¹, Xing Zhou¹, Qin Sun¹, Hui Chen^{1

3}, Wei Chang¹, Qin Gu^#², Jianfeng Xie^#¹, Yi Yang^#¹

Affiliations

¹ Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, People's Republic of China.
² Department of Critical Care Medicine, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, People's Republic of China.
³ Department of Critical Care Medicine, The First Affiliated Hospital of Soochow University, Soochow University, Suzhou, 215000, People's Republic of China.

^# Contributed equally.

Abstract

Purpose: Immune dysfunction plays a pivotal role in sepsis pathogenesis. Previous studies have revealed the crucial role of T cells and human leukocyte antigen-DR (HLA-DR) in sepsis. However, the function of natural killer (NK) cells remains unclear. This study aimed to investigate whether NK cells are associated with sepsis prognosis. In addition, we aimed to explore the interrelation and influence between NK and other immunological features in patients with sepsis.

Patients and methods: This retrospective, observational study included patients with sepsis from two hospitals in mainland China. The clinical characteristics and immune results during the early phase were collected. Patients were classified according to the level of immune cells to analyze the relationship between immunological features and 28-day mortality.

Results: A total of 984 patients were included in this study. Non-survivors were older and had lower levels of lymphocytes, monocytes, NK cells, HLA-DR, and T cells. Patients were classified into eight groups according to their levels of NK cells, HLA-DR, and T cells. Only patients with decreased NK and T cell counts showed a significant increase in 28-day mortality. An increase in CD8+ T cells was correlated with the alleviation of 28-day mortality only among patients with high NK cell levels.

Conclusion: This study provides novel insights into the association between NK cells and 28-day mortality as well as the interrelation between NK cells and other immune cells in sepsis. The relationship between CD8+ T cells and 28-day mortality in sepsis is dependent on NK cell count.

Keywords: HLA-DR; T cell; immune dysfunction; natural killer cell; sepsis.

Grants and funding

This study was funded by the National Key Research and Development Program (2021YFC2500804), National Natural Science Foundation of China (82072155), National Natural Science Foundation of China (82272210), Jiangsu Provincial Key Research and Development Program (BE2022854), Jiangsu Provincial Medical Innovation Center (CXZX202221), Jiangsu Provincial Medical Key Discipline (Laboratory) (ZDXYS202205), and National Natural Science Foundation of China (81901945).