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Combined dysfunctions of immune cells predict nosocomial infection in critically ill patients

Lookup NU author(s): Professor John Simpson

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Abstract

Nosocomial infection occurs commonly in intensive care units (ICUs). Although critical illness is associated with immune activation, the prevalence of nosocomial infections suggests concomitant immune suppression. This study examined the temporal occurrence of immune dysfunction across three immune cell types, and their relationship with the development of nosocomial infection.A prospective observational cohort study was undertaken in a teaching hospital general ICU. Critically ill patients were recruited and underwent serial examination of immune status, namely percentage regulatory T-cells (Tregs), monocyte deactivation (by expression) and neutrophil dysfunction (by CD88 expression). The occurrence of nosocomial infection was determined using pre-defined, objective criteria.Ninety-six patients were recruited, of whom 95 had data available for analysis. Relative to healthy controls, percentage Tregs were elevated 610 days after admission, while monocyte HLA-DR and neutrophil CD88 showed broader depression across time points measured. Thirty-three patients (35) developed nosocomial infection, and patients developing nosocomial infection showed significantly greater immune dysfunction by the measures used. Tregs and neutrophil dysfunction remained significantly predictive of infection in a Cox hazards model correcting for time effects and clinical confounders {hazard ratio (HR) 2.4 [95 confidence interval (CI) 1.15.4] and 6.9 (95 CI 1.630), respectively, P0.001}. Cumulative immune dysfunction resulted in a progressive risk of infection, rising from no cases in patients with no dysfunction to 75 of patients with dysfunction of all three cell types (P0.0004).Dysfunctions of T-cells, monocytes, and neutrophils predict acquisition of nosocomial infection, and combine additively to stratify risk of nosocomial infection in the critically ill.


Publication metadata

Author(s): Morris AC, Anderson N, Brittan M, Wilkinson TS, McAuley DF, Antonelli J, McCulloch C, Barr LC, Dhaliwal K, Jones RO, Haslett C, Hay AW, Swann DG, Laurenson IF, Davidson DJ, Rossi AG, Walsh TS, Simpson AJ

Publication type: Article

Publication status: Published

Journal: British Journal of Anaesthesia

Year: 2013

Volume: 111

Issue: 5

Pages: 778-787

Print publication date: 01/11/2013

Online publication date: 10/06/2013

Acceptance date: 22/04/2013

ISSN (print): 0007-0912

ISSN (electronic): 1471-6771

Publisher: Oxford University Press

URL: http://dx.doi.org/10.1093/bja/aet205

DOI: 10.1093/bja/aet205


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