[The prognostic role of the programmed death-1 expression on T lymphocytes in septic patients].

Objective: To investigate the value of programmed death-1（PD-1） expression on the T lymphocytes for the prognosis of septic patients. Methods: From September 2017 to May 2019, septic patients were included in Department of Intensive Care Unit at 6 hospitals. The PD-1 expression on T cells were measured by flow cytometry. Logistic regression was conducted to analyze independent risk factors related to death within 28 days，and receiver operating characteristic curve(ROC) was conducted to evaluate the prognostic value of PD-1 expression on T cells in septic patients. Results: A total of 64 septic patients were enrolled to this study，including 32 survivors and 32 deaths. The PD-1 expression on T cells in the death group was significantly higher than that in the surviving group (P<0.05). Correlation analysis showed that the percentages of PD-1+/CD3+T cells and PD-1+/CD8+T cells were positively correlated with procalciton in (r=0.313, P =0.015；r=0.375, P=0.003), logistic regression analysis showed that the percentages of PD-1+/CD3+，PD-1+/CD4+，PD-1+/CD8+T cells were independent risk factors for the death of sepsis patients. The percentage of PD-1+/CD3+T cell was 3.63%, with AUC 0.842, sensitivity to predict the mortality 96.43% and specificity 59.38%, (P<0.000 1). The percentage of PD-1+/CD4+T cell was 4.65%, with AUC 0.847, sensitivity 96.43%, specificity 62.50%，(P<0.000 1). The percentage of PD-1+/CD8+T cell was 3.91%, with AUC 0.771, sensitivity 64.29%, specificity 81.25%，(P=0.000 3). Conclusions: The T cell PD-1 expression is an independent risk factor to predict the 28-day mortality in septic patients. Combining the proportions of PD-1+/CD3+, PD-1+/CD4+and PD-1+/CD8+T cells may further enhance the predictive value for death.目的： 探讨T细胞表面程序性死亡受体-1（PD-1）表达水平在预测脓毒症患者预后的价值。 方法： 入选2017年9月—2019年5月6所医院重症医学科的脓毒症患者，流式细胞术测患者外周血T细胞表面PD-1表达水平。Logistic回归分析影响脓毒症患者死亡的独立危险因素，受试者操作特征（ROC）曲线分析T细胞表面PD-1表达对脓毒症患者预后的预测价值。 结果： 共纳入脓毒症患者64例，生存者32例，死亡者32例。第1、2、3、5、7天死亡者PD-1+/CD3+T细胞百分比、PD-1+/CD4+T细胞百分比高于生存者（P<0.05）。相关性分析显示，PD-1+/CD3+T细胞百分比、PD-1+/CD8+T细胞百分比与降钙素原呈正相关（r=0.313, P=0.015；r=0.375, P =0.003）。Logistic回归分析显示，第3天PD-1+/CD3+T细胞百分比、PD-1+/CD4+T细胞百分比、PD-1+/CD8+T细胞百分比是影响脓毒症患者死亡的独立危险因素。PD-1+/CD3+T细胞百分比为3.63%，预测脓毒症患者28 d死亡的敏感度 96.43%，特异度 59.38%。PD-1+/CD4+T细胞百分比为4.65%，预测脓毒症患者28 d死亡的敏感度 96.43%，特异度 62.50%。PD-1+/CD8+T细胞百分比为3.91%，预测脓毒症患者28 d死亡的敏感度 64.29%，特异度81.25%。 结论： 脓毒症死亡者T细胞表面PD-1表达水平更高，T细胞表面PD-1表达增加是影响脓毒症患者死亡的独立危险因素，对脓毒症患者28 d死亡有较好的预测价值，联合使用PD-1+/CD3+T细胞百分比、PD-1+/CD4+T细胞百分比、PD-1+/CD8+T细胞百分比进一步提高对预后的预测价值。.