Th17, rather than Th1 cell proportion, is closely correlated with elevated disease severity, higher inflammation level, and worse prognosis in sepsis patients

Abstract

Objective: The current study aimed to investigate the prognostic value of T helper (Th) 1 and Th17 proportions in sepsis patients.

Methods: Th1 and Th17 cells in blood CD4⁺ T cells were detected by flow cytometry in 210 sepsis patients and 100 healthy controls (HCs). Besides, serum interferon-γ (IFN-γ), tumor necrosis factor-α (TNF-α), and interleukin-17 (IL-17) levels in the enrolled sepsis patients were determined with enzyme-linked immunosorbent assay.

Results: Compared with HCs, Th1 and Th17 proportions were elevated in sepsis patients (both p < .001). Meanwhile, Th1 proportion was strongly correlated with IFN-γ (p < .001, r = .484) but weakly correlated with TNF-α (p = .024, r = .156) and IL-17 (p = .002, r = .212), while Th17 proportion showed faint correlation with IFN-γ (p = .015, r = .168), but strong correlations with TNF-α (p < .001, r = .602) and IL-17 (p < .001, r = .498) in sepsis patients. Besides, Th1 proportion was weakly associated with APACHE II score (p = .030, r = .150), but Th17 proportion was closely associated with APACHE II score (p < .001, r = .322) and SOFA score (p < .001, r = .337) in sepsis patients. Regarding their prognostic value, Th1 proportion (p = .042) was slightly, while Th17 proportion (p < .001) was dramatically, increased in septic deaths compared with survivors, and Th17 possessed good predictive value for 28-day mortality risk (AUC: 0.748, 95% CI: 0.659-0.836).

Conclusion: Th1 and Th17 proportions are elevated in sepsis patients compared with HCs, and Th17 proportion is correlated with increased disease severity, higher inflammation level, and worse prognosis in sepsis patients.

Keywords: 28-day mortality; Comprehensive disease severity scale; Sepsis; Th1; Th17.

FIGURE 1

Detection of Th1 and Th17 cell proportions in sepsis patients and HCs. Comparison of Th1 (A) and Th17 (B) cell proportions between sepsis patients and HCs. The value of Th1 (C) and Th17 (D) cell proportions in discriminating sepsis patients from HCs by ROC curves. Th, T helper; HC, healthy control; AUC, area under the curve; CI, confidence interval; ROC, receiver's operating characteristic

FIGURE 2

Correlation analysis in Th1 and Th17 cell proportions with their related cytokines in sepsis patients. Correlation in Th1 cell proportion with IFN‐γ (A), IL‐17 (B) and TNF‐α (C). Correlation in Th17 cell proportion with IFN‐γ (D), IL‐17 (E), and TNF‐α (F). Th, T helper; IFN‐γ, interferon‐γ; IL‐17, interleukin‐17; TNF‐α, tumor necrosis factor‐α

FIGURE 3

Correlation analysis in Th1 and Th17 cell proportions with disease severity in sepsis patients. Correlation in Th1 cell proportion with APACHE II score (A) and SOFA score (B). Correlation in Th17 cell proportion with APACHE II score (C) and SOFA score (D). Th, T helper; APACHE II, acute physiology and chronic health evaluation II; SOFA, sequential organ failure assessment

FIGURE 4

Detection of Th1 and Th17 cell proportions in septic deaths and survivors. Comparison of Th1 (A) and Th17 (B) cell proportions between septic deaths and survivors. Th, T helper

FIGURE 5

Value of Th1 and Th17 cell proportions in discriminating septic deaths from survivors. A, The value of Th1 and Th17 cell proportions in discriminating septic deaths from survivors; (B) The value of IFN‐γ, IL‐17, and TNF‐α in discriminating septic deaths from survivors; (C) The value of APACHE II score and SOFA score in discriminating septic deaths from survivors. Th, T helper; AUC, area under the curve; CI, confidence interval; IFN‐γ, interferon‐γ; IL‐17, interleukin‐17; TNF‐α, tumor necrosis factor‐α; APACHE II, acute physiology and chronic health evaluation II; SOFA, sequential organ failure assessment

FIGURE 6

Accumulating mortality in Th1 high/low‐expression patients and Th17 high/low‐expression patients. A, Comparison of accumulating mortality between Th1 high‐expression patients and Th1 low‐expression patients; (B) Comparison of accumulating mortality between Th17 high‐expression patients and Th17 low‐expression patients. Th, T helper