P.39The use of the expression of T-cell surface markersto characterize the immune function in critically ill patients

1997 ◽  
Vol 16 ◽  
pp. 33
Author(s):  
P. Essén ◽  
G. Wu ◽  
K. Andersson ◽  
R. Lenkei ◽  
J. Wernerman
Keyword(s):  
T Cell ◽  
Cell Surface ◽  
Immune Function ◽  
Critically Ill ◽  
Critically Ill Patients

scholarly journals Immunonutrition in surgical and critically ill patients

2007 ◽  
Vol 98 (S1) ◽  
pp. S133-S139 ◽  
Author(s):  
Philip C. Calder
Keyword(s):  
Fatty Acids ◽  
Immune Function ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Experimental Studies ◽  
Good Evidence ◽  
Antioxidant Vitamins ◽  
Surgical Patients ◽  
Susceptibility To Infection ◽  
Long Chain

Surgery, trauma, burns and injury induce an inflammatory response that can become excessive and damaging in some patients. This hyperinflammation can be followed by an immunosuppressed state which increases susceptibility to infection. The resulting septic syndromes are associated with significant morbidity and mortality. A range of nutrients are able to modulate inflammation (and the associated oxidative stress) and to maintain or improve immune function. These include several amino acids, antioxidant vitamins and minerals, long-chain n-3 fatty acids and nucleotides. Experimental studies support a role for each of these nutrients in surgical, injured or critically ill patients. There is good evidence that glutamine influences immune function in such patients and that this is associated with clinical improvement. Evidence is also mounting for the use of long-chain n-3 fatty acids in surgical and septic patients, but more evidence of clinical efficacy is required. Mixtures of antioxidant vitamins and minerals are also clinically effective, especially if they include selenium. Their action appears not to involve improved immune function, although an anti-inflammatory mode of action has not been ruled out. Enteral immunonutrient mixtures, usually including arginine, nucleotides and long-chain n-3 fatty acids, have been used widely in surgical and critically ill patients. Evidence of efficacy is good in surgical patients. However whether these same mixtures are beneficial, or should even be used, in critically ill patients remains controversial, since some studies show increased mortality with such mixtures. There is a view that this is due to a high arginine content driving nitric oxide production.

Mitochondrial DNA

2016 ◽  
Vol 124 (4) ◽  
pp. 923-933 ◽  
Author(s):  
Simon T. Schäfer ◽  
Lars Franken ◽  
Michael Adamzik ◽  
Beatrix Schumak ◽  
André Scherag ◽  
...  
Keyword(s):  
Mitochondrial Dna ◽  
T Cell ◽  
Critically Ill ◽  
Knockout Mice ◽  
Critically Ill Patients ◽  
Adenosine Triphosphatase ◽  
Serum Concentrations ◽  
Wild Type ◽  
Molecular Pattern ◽  
D Loop

Abstract Background Critically ill patients are at high risk to suffer from sepsis, even in the absence of an initial infectious source, but the molecular mechanisms for their increased sepsis susceptibility, including a suppressed immune system, remain unclear. Although microbes and pathogen-associated molecular pattern are accepted inducers of sepsis and septic immunosuppression, the role of endogenous Toll-like receptor (TLR) ligands, such as mitochondrial DNA (mtDNA), in altering the immune response is unknown. Methods Mitochondrial DNA serum concentrations of the mitochondrial genes D-Loop and adenosine triphosphatase 6 were determined (quantitative polymerase chain reaction) in 165 septic patients and 50 healthy volunteers. Furthermore, cytotoxic T-cell activity was analyzed in wild-type and TLR9 knockout mice, with/without previous mtDNA administration, followed by injection of an ovalbumin-expressing adenoviral vector. Results Mitochondrial DNA serum concentrations were increased in septic patients (adenosine triphosphatase 6, 123-fold; D-Loop, 76-fold, P < 0.0001) compared with volunteers. Furthermore, a single mtDNA injection caused profound, TLR9-dependent immunosuppression of adaptive T-cell cytotoxicity in wild-type but not in TLR9 knockout mice and evoked various immunosuppressive mechanisms including the destruction of the splenic microstructure, deletion of cross-presenting dendritic cells, and up-regulation of programmed cell death ligand 1 and indoleamine 2,3-dioxygenase. Several of these findings in mice were mirrored in septic patients, and mtDNA concentrations were associated with an increased 30-day mortality. Conclusions The findings of this study imply that mtDNA, an endogenous danger associated molecular pattern, is a hitherto unknown inducer of septic immunoparalysis and one possible link between initial inflammation and subsequent immunosuppression in critically ill patients.

Invasive Fungal Disease in Critically Ill Patients at High Risk: Usefulness of Lymphocyte Subtyping

2018 ◽  
Vol 35 (9) ◽  
pp. 909-918 ◽  
Author(s):  
Jiahui Zhang ◽  
Na Cui ◽  
Hao Wang ◽  
Wen Han ◽  
Yuanfei Li ◽  
...  
Keyword(s):  
T Cell ◽  
High Risk ◽  
Cell Count ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Invasive Fungal Disease ◽  
Rank Test ◽  
Icu Admission ◽  
Cell Counts ◽  
Log Rank Test

Objectives: This study aimed to investigate the distinguishing ability of lymphocyte subtyping for diagnosis and prognosis of invasive fungal disease (IFD). Methods: We assessed lymphocyte subtyping and evaluated the quantitative changes in key immunological parameters at intensive care unit (ICU) admission in critically ill patients at high risk and their potential influence on diagnosis and outcome of IFD. The primary outcome was 28-day mortality. Results: Among the 124 critically ill patients with mean Candida score 3.89 (0.76), 19 (15.3%) were in the IFD group. CD28+CD8+ T-cell counts (area under the curve [AUC] 0.899, 95% confidence interval [CI], 0.834-0.964, P < .001) had better distinguishing ability than other immune parameters for IFD diagnosis. The cutoff value of CD28+CD8+ T-cell counts at ICU admission for IFD diagnosis was 59.5 cells/mm3, with 83.3% sensitivity and 86.4% specificity. Multivariate logistic regression analysis identified CD28+CD8+ T-cell count <59.5 cells/mm3 (odds ratio 59.7, 95% CI, 7.33-486.9, P < .001) as an independent predictor for IFD diagnosis. CD28+CD8+ T-cell counts could also predict 28-day mortality (AUC 0.656, 95% CI, 0.525-0.788, P = .045). Kaplan-Meier survival analysis provided evidence that natural killer cell count <76.0 cells/mm3 (log-rank test; P = .001), CD8+ T-cell count <321.5 cells/mm3 (log-rank test; P = .04), and CD28+CD8+ T-cell count <129.0 cells/mm3 (log-rank test; P = .02) at ICU admission were associated with lower survival probabilities. Conclusion: CD28+CD8+ T-cell counts play an important role in early diagnosis of IFD. Low counts are associated with early mortality in critically ill patients at high risk of IFD. Our findings add evidence to the utility of lymphocyte subtyping in a diagnostic algorithm to better define IFD in critically ill patients at high risk.

scholarly journals Cell-surface signatures of immune dysfunction risk-stratify critically ill patients: INFECT study

2018 ◽  
Vol 44 (5) ◽  
pp. 627-635 ◽  
Author(s):  
Andrew Conway Morris ◽  
Deepankar Datta ◽  
Manu Shankar-Hari ◽  
Jacqueline Stephen ◽  
Christopher J. Weir ◽  
...  
Keyword(s):  
Cell Surface ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Immune Dysfunction

scholarly journals T Cell– and Monocyte-Specific RNA-Sequencing Analysis in Septic and Nonseptic Critically Ill Patients and in Patients with Cancer

2019 ◽  
Vol 203 (7) ◽  
pp. 1897-1908 ◽  
Author(s):  
Michael L. Washburn ◽  
Zhang Wang ◽  
Andrew H. Walton ◽  
S. Peter Goedegebuure ◽  
David J. Figueroa ◽  
...  
Keyword(s):  
T Cell ◽  
Rna Sequencing ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Sequencing Analysis ◽  
Patients With Cancer

scholarly journals Rationale for using new lipid emulsions in parenteral nutrition and a review of the trials performed in adults

2009 ◽  
Vol 68 (3) ◽  
pp. 252-260 ◽  
Author(s):  
Philip C. Calder
Keyword(s):  
Parenteral Nutrition ◽  
Fish Oil ◽  
Immune Function ◽  
Olive Oil ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Adult Patients ◽  
Partial Replacement ◽  
Lipid Emulsions ◽  
Post Surgery

Lipids traditionally used in parenteral nutrition are based on n-6 fatty acid-rich vegetable oils such as soyabean oil. This practice may not be optimal because it may present an excessive supply of linoleic acid. Alternatives to the use of soyabean oil include its partial replacement by so-called medium-chain TAG (MCT), olive oil or fish oil, either alone or in combination. Lipid emulsions containing MCT are well established, but those containing olive oil and fish oil, although commercially available, are still undergoing trials in different patient groups. Emulsions containing olive oil or fish oil are well tolerated and without adverse effects in a wide range of adult patients. An olive oil–soyabean oil emulsion has been used in quite small studies in critically-ill patients and in patients with trauma or burns with little real evidence of advantage over soyabean oil or MCT–soyabean oil. Fish oil-containing lipid emulsions have been used in adult patients post surgery (mainly gastrointestinal). This approach has been associated with alterations in patterns of inflammatory mediators and in immune function and, in some studies, a reduction in the length of stay in the intensive care unit and in hospital. One study indicates that peri-operative administration of fish oil may be superior to post-operative administration. Fish oil has been used in critically-ill adults. Here, the influence on inflammatory processes, immune function and clinical end points is not clear, since there are too few studies and those that are available report contradictory findings. One important factor is the dose of fish oil required to influence clinical outcomes. Further studies that are properly designed and adequately powered are required in order to strengthen the evidence base relating to the use of lipid emulsions that include olive oil and fish oil in critically-ill patients and in patients post surgery.

118: RESOURCE UTILIZATION IN THE ICU IN CRITICALLY ILL PATIENTS FOLLOWING CAR T CELL THERAPY

2020 ◽  
Vol 48 (1) ◽  
pp. 42-42 ◽  
Author(s):  
Anne Rain Brown ◽  
Irfan Jindani ◽  
Judd Melancon ◽  
Rose Erfe ◽  
Lei Feng ◽  
...  
Keyword(s):  
T Cell ◽  
Cell Therapy ◽  
Critically Ill ◽  
Resource Utilization ◽  
Critically Ill Patients ◽  
T Cell Therapy ◽  
Car T Cell ◽  
Car T Cell Therapy ◽  
Car T

scholarly journals Prognostic Relevance of Altered Lymphocyte Subpopulations in Critical Illness and Sepsis

2019 ◽  
Vol 8 (3) ◽  
pp. 353 ◽  
Author(s):  
Philipp Hohlstein ◽  
Hendrik Gussen ◽  
Matthias Bartneck ◽  
Klaudia Theresa Warzecha ◽  
Christoph Roderburg ◽  
...  
Keyword(s):  
T Cells ◽  
Intensive Care ◽  
T Cell ◽  
Critical Illness ◽  
Healthy Volunteers ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Peripheral Blood ◽  
Icu Patients ◽  
T Cell Depletion

Lymphopenia and functional defects in lymphocytes may impact the prognosis in patients with critical illness or sepsis. Therefore, we prospectively analyzed peripheral blood leukocytes from 63 healthy volunteers, 50 non-critically ill standard care (SC) patients with infections, and 105 intensive care unit (ICU) patients (52 with sepsis, 53 without sepsis) using flow cytometry. Compared to healthy volunteers, SC and ICU patients showed significant leukocytosis, especially in sepsis, while lymphocyte numbers were significantly decreased. All major lymphocyte populations (B, T, and natural killer (NK) cells) decreased in ICU patients. However, we observed a relative reduction of T cells, alongside decreased CD8+ T cells, in critically ill patients, independent of sepsis. High absolute T cell counts (>0.36/nL) at ICU admission were associated with a significantly reduced mortality, independent of patient’s age. Moreover, patients that survived ICU treatment showed dynamic changes within 48 h towards restoration of lymphopenia and T cell depletion, while non-surviving patients failed to restore lymphocyte counts. In conclusion, the flow-cytometric analysis of peripheral blood revealed striking changes in circulating lymphocyte subsets in critically ill patients, independent of sepsis. Lymphopenia and T cell depletion at ICU admission were associated with increased mortality, supporting their relevance as predictive biomarkers and potential therapeutic targets in intensive care medicine.

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