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. 2021 Oct 20:14:5433-5442.
doi: 10.2147/JIR.S321507. eCollection 2021.

Immune Dysfunction is Associated with Readmission in Survivors of Sepsis Following Infected Pancreatic Necrosis

Jiangtao Yin #  1   2 , Wenjian Mao #  1 , Xiaojia Xiao  3 , Xianqiang Yu  4 , Baiqiang Li  5 , Faxi Chen  5 , Jiajia Lin  5 , Jing Zhou  1 , Jing Zhou  4 , Zhihui Tong  5 , Lu Ke  5 , Weiqin Li  1   5
Affiliations

Immune Dysfunction is Associated with Readmission in Survivors of Sepsis Following Infected Pancreatic Necrosis

Jiangtao Yin et al. J Inflamm Res. .

Abstract

Objective: Immunosuppression is common in patients with infected pancreatic necrosis (IPN) and associated with morbidity and mortality. This study aimed to investigate the impact of immune status on mortality and readmission after hospital discharge in patients with IPN-related sepsis.

Methods: In this prospective observational study, eligible adult patients with IPN-related sepsis requiring ICU admission were included. Monocytic human leukocyte antigen DR (mHLA-DR), expression of regulatory T cells (Treg), and neutrophil CD88 (nCD88) were measured on the diagnosis of sepsis, ICU discharge, hospital discharge, and 15, 30, 60 days after hospital discharge. Logistic regression model was used to assess potential risk factors for readmission 60-days within the index discharge.

Results: A total of 53 patients were included, 13 died during hospitalization and one withdrew the consent soon after discharge. Among the survivors, a tendency of immune recovery was observed during the consecutive follow-ups, evidenced by the increased expression of mHLA-DR. Sixteen patients (41.03%) were readmitted within 60 days after the index discharge. In the multivariable regression model, APACHE II score when sepsis was diagnosed >9 and mHLA-DR at discharged <14,591 AB/C were found to be independent risk factors affecting readmission.

Conclusion: Immunosuppression is common in patients with IPN-related sepsis and can persist until two months after discharge. The compromised mHLA-DR level at discharge was associated with readmission within two months after discharge.

Keywords: immunosuppression; infected pancreatic necrosis; monocyte HLA-DR; readmissions; sepsis.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Figure 1
Figure 1
Flow chart of the participants.
Figure 2
Figure 2
The immune trajectory of the survivors. (A) mHLA-DR expression from enrollment to 60 days post hospital discharge. (B) Treg expression from enrollment to 60 days post hospital discharge. (C) nCD88 expression from enrollment to 60 days post hospital discharge. Each band in the figure was shown as median (IQR). *P < 0.05; **P < 0.01; ***P < 0.001.
Figure 3
Figure 3
Generalized estimating equations of three immune markers between the two groups. (A) The evolution of mHLA-DR was different between the two groups (P = 0.001). (B and C) There was no difference between the two groups of the evolution of Treg and nCD88 (P > 0.05).
Figure 4
Figure 4
Receiver operator characteristic analysis for age (A), prealbumin when sepsis was diagnosed (B), APACHE II score when sepsis was diagnosed (C) and mHLA-DR at discharged (D).
See this image and copyright information in PMC

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