Background Sepsis is a life-threatening syndrome characterized by organ dysfunction due to dysregulated host immune responses. This study investigates dynamic changes in immune cells during sepsis progression and evaluates their utility as predictive biomarkers for sepsis prognosis. Methods In this retrospective study, immune cells from 220 patients with sepsis were compared with those of 70 healthy controls. Patients with sepsis were stratified by 28-day outcome into survivors (n = 148) and non-survivors (n = 72). Immune cells included the counts and percentages of neutrophils, lymphocytes and monocytes; the percentages of CD3+ T cells, CD3+CD4+ T cells and CD3+CD8+ T cells. The neutrophil/lymphocyte ratio (NLR) and monocyte/lymphocyte ratio (MLR) were also calculated. Immune parameters were monitored on days 1, 3, 7, 14, 21, and 28 after sepsis diagnosis to characterize dynamic trajectories. Results The count and percentage of neutrophils, the count of monocytes, NLR, MLR and CRP in patients with sepsis were significantly increased, while the count and percentage of lymphocytes, the percentage of monocytes, the percentages of CD3+ T cells and CD3+CD8+ T cells were lower as compared to the control. The NLR demonstrated a diagnostic accuracy for sepsis with an area under the curve (AUC) of 0.981 (95% CI: 0.965 ~ 0.998). The percentage of neutrophils achieved an AUC of 0.980 (95% CI: 0.958 ~ 1.000). The percentage of neutrophils and NLR performed comparably to CRP and outperformed other immune cell indices. The count of monocytes on day 7, the percentage of monocytes on day 7 and 21, the count of lymphocytes on day 7 and 14, the percentage of lymphocytes on day 7, 14 and 21 in the non-survival group were lower than those in the survival group. The percentage of neutrophils and NLR on day 7, 14 and 21 in the non-survival group were higher than that in the survival group. Conclusions The percentages of lymphocytes and monocytes in the survivors of sepsis trend upward over time. The percentage of neutrophils and NLR show potential as a prognostic biomarker for sepsis and may be useful to predict 28-day hospital mortality in patients with sepsis. Day 7 may represent a critical window for prognostic assessment in sepsis.

Monitoring immune cell dynamics for potential prognostic biomarker of sepsis

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2025年12月29日

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Huili Ma,
Jia Di,
Shuang Xiao,
Li Chen,
Weifeng Zhao,
Juanjuan Cui

摘要

Background

Sepsis is a life-threatening syndrome characterized by organ dysfunction due to dysregulated host immune responses. This study investigates dynamic changes in immune cells during sepsis progression and evaluates their utility as predictive biomarkers for sepsis prognosis.

Methods

In this retrospective study, immune cells from 220 patients with sepsis were compared with those of 70 healthy controls. Patients with sepsis were stratified by 28-day outcome into survivors (n = 148) and non-survivors (n = 72). Immune cells included the counts and percentages of neutrophils, lymphocytes and monocytes; the percentages of CD3⁺ T cells, CD3⁺CD4⁺ T cells and CD3⁺CD8⁺ T cells. The neutrophil/lymphocyte ratio (NLR) and monocyte/lymphocyte ratio (MLR) were also calculated. Immune parameters were monitored on days 1, 3, 7, 14, 21, and 28 after sepsis diagnosis to characterize dynamic trajectories.

Results

The count and percentage of neutrophils, the count of monocytes, NLR, MLR and CRP in patients with sepsis were significantly increased, while the count and percentage of lymphocytes, the percentage of monocytes, the percentages of CD3⁺ T cells and CD3⁺CD8⁺ T cells were lower as compared to the control. The NLR demonstrated a diagnostic accuracy for sepsis with an area under the curve (AUC) of 0.981 (95% CI: 0.965 ~ 0.998). The percentage of neutrophils achieved an AUC of 0.980 (95% CI: 0.958 ~ 1.000). The percentage of neutrophils and NLR performed comparably to CRP and outperformed other immune cell indices. The count of monocytes on day 7, the percentage of monocytes on day 7 and 21, the count of lymphocytes on day 7 and 14, the percentage of lymphocytes on day 7, 14 and 21 in the non-survival group were lower than those in the survival group. The percentage of neutrophils and NLR on day 7, 14 and 21 in the non-survival group were higher than that in the survival group.

Conclusions

The percentages of lymphocytes and monocytes in the survivors of sepsis trend upward over time. The percentage of neutrophils and NLR show potential as a prognostic biomarker for sepsis and may be useful to predict 28-day hospital mortality in patients with sepsis. Day 7 may represent a critical window for prognostic assessment in sepsis.