Jiahui Zhang1, Na Cui2, Yun Long3, Hao Wang4, Wen Han5, Yuanfei Li6, Meng Xiao7. 1. Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China. Electronic address: zhangjiahui_1222@163.com. 2. Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China. Electronic address: pumchcn@163.com. 3. Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China. Electronic address: ly_icu@aliyun.com. 4. Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China. Electronic address: newwanghao@gmail.com. 5. Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China. Electronic address: hanwenqy@163.com. 6. Department of Critical Care Medicine, Changsha Central Hospital, Changsha 410004, China. Electronic address: 156636305@qq.com. 7. Department of Clinical Laboratory, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China; Beijing Key Laboratory for Mechanisms Research and Precision Diagnosis of Invasive Fungal Diseases, Beijing 100730, China. Electronic address: cjtcxiaomeng@aliyun.com.
Abstract
OBJECTIVES: This study aimed to investigate the distinguishing ability of lymphocyte subtyping for Invasive candidiasis (IC) diagnosis and prognosis in non-neutropenic critically ill patients. METHODS: We assessed the quantitative changes in key parameters of lymphocyte subtyping at the onset of clinical signs of infection in non-neutropenic critically ill patients and their potential influence on diagnosis and outcome of IC. The primary outcome was 28-day mortality. RESULTS: Among the 182 consecutive critically ill patients, 22 (12.1%) were in the IC group. The CD28+CD8+ T-cell counts (AUC 0.863, 95%CI 0.804-0.909, P<0.001) had greater diagnostic value for IC than other parameters had. Adding CD28+CD8+ T to Candida score significantly improved the predictive value of Candida score (P=0.039). Multivariate logistic regression analysis identified CD28+CD8+ T-cell counts≤78 cells/mm3 (OR 24.544, 95%CI 6.461-93.236, P<0.001) as an independent predictor for IC diagnosis. CD28+CD8+ T-cell counts could also predict 28-day mortality. Kaplan-Meier survival analysis provided evidence that CD28+CD8+ T-cell count <144cells/mm3 (log-rank test; P=0.03) were associated with lower survival probabilities. CONCLUSIONS: CD28+CD8+ T-cell counts play an important role in early diagnosis of IC. Low counts are associated with early mortality in non-neutropenic critically ill patients. These results suggest the potential usefulness of measuring CD28+CD8+ T-cell lymphocyte levels in the early recognition and diagnosis of IC. TRIAL REGISTRATION: ChiCTR-ROC-17010750. Registered 28 February 2017.
OBJECTIVES: This study aimed to investigate the distinguishing ability of lymphocyte subtyping for Invasive candidiasis (IC) diagnosis and prognosis in non-neutropenic critically illpatients. METHODS: We assessed the quantitative changes in key parameters of lymphocyte subtyping at the onset of clinical signs of infection in non-neutropenic critically illpatients and their potential influence on diagnosis and outcome of IC. The primary outcome was 28-day mortality. RESULTS: Among the 182 consecutive critically ill patients, 22 (12.1%) were in the IC group. The CD28+CD8+ T-cell counts (AUC 0.863, 95%CI 0.804-0.909, P<0.001) had greater diagnostic value for IC than other parameters had. Adding CD28+CD8+ T to Candida score significantly improved the predictive value of Candida score (P=0.039). Multivariate logistic regression analysis identified CD28+CD8+ T-cell counts≤78 cells/mm3 (OR 24.544, 95%CI 6.461-93.236, P<0.001) as an independent predictor for IC diagnosis. CD28+CD8+ T-cell counts could also predict 28-day mortality. Kaplan-Meier survival analysis provided evidence that CD28+CD8+ T-cell count <144cells/mm3 (log-rank test; P=0.03) were associated with lower survival probabilities. CONCLUSIONS:CD28+CD8+ T-cell counts play an important role in early diagnosis of IC. Low counts are associated with early mortality in non-neutropenic critically illpatients. These results suggest the potential usefulness of measuring CD28+CD8+ T-cell lymphocyte levels in the early recognition and diagnosis of IC. TRIAL REGISTRATION: ChiCTR-ROC-17010750. Registered 28 February 2017.