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EFFECT OF STRATIFIED DOSE OF NOREPINEPHRINE ON CELLULAR IMMUNE RESPONSE IN PATIENTS WITH SEPTIC SHOCK AND THE CONSTRUCTION OF A PROGNOSTIC RISK MODEL

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机构： [1]Department of Geriatric Intensive Care Medicine, the First Affiliated Hospital of Kunming Medical University, Yunnan Geriatric Medicine Center, Kunming, 650032. [2]Stomatology Research Center, The First People's Hospital of Yunnan Province, Kunming, 650034. [3]Department of Emergency Medicine, Yunnan First People's Hospital, Kunming, 650034.

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关键词： Norepinephrine Septic shock Prognostic risk model Cellular immune response Stratified dose

摘要：

To explore the effect of a stratified dose of norepinephrine (NE) on cellular immune response in patients with septic shock, and to construct a prognostic model of septic shock.A total of 160 patients with septic shock (B group) and 58 patients with sepsis (A group) were given standard cluster therapy. Patients with septic shock were divided into four groups (B1-B4 groups: 0.01-0.2, 0.2-0.5, 0.5-1.0, and > 1 μg/kg/min) according to the quartile method of the early (72 h) time-weighted average dose of NE and clinical application. The cellular immune indexes at 24 h (T0) and 4-7 days (T1) after admission were collected. The difference method was used to explore the effect of NE stratified dose on cellular immune effect in patients with septic shock. A multivariate COX proportional risk regression model was used to analyze the independent prognostic risk factors, and a prognostic risk model was constructed.The differences of ΔIL-1β, ΔIL-6, ΔIL-10, absolute value difference of T lymphocyte (ΔCD3+/CD45 + #) and Th helper T cell (ΔCD3+ CD4+/CD45 + #), CD64 infection index difference, ΔmHLA-DR, regulatory T lymphocyte ratio difference (ΔTregs%) between group A, B1, B2, B3 and B4 were statistically significant (p < 0.05). There was a nonlinear relation between the stratified dose of NE and ΔIL-6, ΔIL-10, ΔCD3+/CD45 + #, ΔmHLA-DR%. The threshold periods of NE-induced pro-inflammatory and anti-inflammatory immune changes were 0.3-0.5 μg/kg/min. Multivariate COX model regression analysis showed that age, nutritional patterns, weighted average dose of norepinephrine, IL-6, absolute value of T lymphocytes, and mHLA-DR were independent risk factors affecting the prognosis of patients with septic shock (p < 0.05). The prognostic risk model was constructed (AUC value = 0.813, 95%CI: 0.752-0.901).NE has a certain inhibitory effect on cellular immune function in patients with septic shock. A prognostic risk model was constructed with stronger prediction efficiency for the prognosis of patients with septic shock.Copyright © 2024 by the Shock Society.

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最新[2023]版：

大类 | 3 区医学

小类 | 3 区血液学 3 区外周血管病 3 区外科 4 区危重病医学

JCR分区：

出版当年[2023]版：

Q1 SURGERY Q2 CRITICAL CARE MEDICINE Q2 HEMATOLOGY Q2 PERIPHERAL VASCULAR DISEASE

最新[2023]版：

Q1 SURGERY Q2 CRITICAL CARE MEDICINE Q2 HEMATOLOGY Q2 PERIPHERAL VASCULAR DISEASE

影响因子： 2.7 最新[2023版] 2.8 最新五年平均 2.7 出版当年[2023版] 2.8 出版当年五年平均 3.1 出版前一年[2022版]

第一作者：

第一作者机构： [1]Department of Geriatric Intensive Care Medicine, the First Affiliated Hospital of Kunming Medical University, Yunnan Geriatric Medicine Center, Kunming, 650032.

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通讯作者：

通讯机构： [1]Department of Geriatric Intensive Care Medicine, the First Affiliated Hospital of Kunming Medical University, Yunnan Geriatric Medicine Center, Kunming, 650032. [*1]No. 295 Xichang Road, Wuhua District, Kunming City, Yunnan Province, 650032, China.

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EFFECT OF STRATIFIED DOSE OF NOREPINEPHRINE ON CELLULAR IMMUNE RESPONSE IN PATIENTS WITH SEPTIC SHOCK AND THE CONSTRUCTION OF A PROGNOSTIC RISK MODEL

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