Early prognosis in severe sepsis via analyzing the monocyte immunophenotype

Objective: To analyze the early discriminative predictive information regar ding the immunophenotype components of patients with sepsis, and its potent ial use as a prognosis tool. Design: Observational prospective clinical study. Setting: Intensive care unit (ICU) in a University Hospital. Patients: Thirty-five patients admit ted with severe sepsis. Measurements: Analysis of peripheral blood on admission and 48 h later of t he absolute white cell count and the immunophenotype of lymphocyte (CD3, CD 3-HLADR, CD4, CD8, CD4/CD8 ratio, CD19, and CD25) and monocyte (CD13, CD13- HLADR, CD14, CD14-HLADR, CD13-CD14, and CD4) subpopulations. Results: Due to its high correlation, the immunophenotypic profile stud led at admission and 48 h later showed the same prognosis power regardless of the time of performance. The univariate analysis between groups (survival v ersus death) confirmed the prognostic significance of the total monocyte co unt and its subpopulations; significant differences were observed from the beginning only in the CD19 lymphocyte subpopulation. Multivariate analysis was performed using logistic regression with survival as the dependent vari able. The final model comprised monocytes beta = 0.002 (P = 0.025) and CD13 -HLADR beta = 0.016 (P = 0.029). The monocytes receiver operating character istic (ROC) area obtained was 0.819 (confidence interval 0.663-0.976 at 95 %), the CD13-KLADR ROC area was 0.810 (confidence interval 0.658-0.963), an d the monocytes + CD13-HLADR ROC area was 0.918 (confidence interval 0.807- 1.000). Conclusions: A single blood sample test obtaining the absolute monocyte and CD13-KLADR subpopulation count in the first days of admission could contri bute to simplifying the classification of patients with severe sepsis into high- and low-mortality risk.