Impaired T Lymphocyte Subsets Early Predict Acute Kidney Injury in Sepsis Patients
Abstract Objective: Acute kidney injury (AKI) is a frequent complication of sepsis patients and is associated with high morbidity and mortality. Early recognition of sepsis-associated AKI (SA-AKI) is crucial to provide supportive treatment and improve prognosis. Thus, the objective is to analyze the early discriminative predictive information regarding T lymphocyte subsets of SA-AKI.Methods: We evaluated the relationships of T lymphocyte subsets and clinical parameters of sepsis patients, and assessed their potential roles in SA-AKI diagnosis. The following T lymphocyte subsets were studied: total T lymphocyte (CD3+), helper T lymphocyte (T helper, CD3+CD4+), cytotoxic T lymphocyte (CTL, CD3+CD8+), totally activated T lymphocyte (CD3+HLADR+), early activated T lymphocyte (CD4+CD69+, CD8+CD69+), regulatory T lymphocyte (Treg, CD4+CD25+, CD8+CD25+).Results: A total of 171 patients with sepsis were enrolled. The incidence of AKI was 80.1%. The percentages of total T lymphocyte, CTL, and totally activated T lymphocyte of SA-AKI patients were lower than those of sepsis patients without AKI (61.95±19.65 % vs 68.80±18.57 %, 19.95±17.22 % vs 26.48±18.31 %, 19.00±14.21 % vs 30.88±28.86 %, respectively, P<0.05). There were no significant differences in the percentages of T helper, early activated T lymphocyte, and Tregs between SA-AKI group and non-SA-AKI group. Univariate logistic regression analysis showed that percentages of total T lymphocyte, CTL, and totally activated T lymphocyte were protective factors for SA-AKI. Multivariate logistic regression analysis revealed that percentage of totally activated T lymphocyte had a negative association with SA-AKI independently (OR: 0.952, 95% CI: 0.926-0.978, P=0.000). Moreover, ROC analysis showed that total T lymphocyte, CTL, and totally activated T lymphocyte had discriminatory abilities, with areas under the curve (AUC) value of 0.638, 0.615, and 0.661, respectively (P<0.05). Conclusions: Impaired total T lymphocyte, CTL, and totally activated T lymphocyte could contribute to early diagnosis for SA-AKI.