title: CD4+ lymphocyte adenosine triphosphate determination in sepsis: a cohort study.
abstract: BACKGROUND
  Patients suffering from sepsis are currently classified on a clinical basis (i.e., sepsis, severe sepsis, septic shock); however, this clinical classification may not accurately reflect the overall immune status of an individual patient. Our objective was to describe a cohort of patients with sepsis in terms of their measured immune status.
  
  
  METHODS
  Fifty-two patients with sepsis (n = 13), severe sepsis (n = 21), or septic shock (n = 18) were studied. The immune status was determined by measuring the CD4+ lymphocyte adenosine triphosphate (ATP) content after mitogen stimulation in whole blood.
  
  
  RESULTS
  The measured CD4+ lymphocyte ATP content at the time of ICU admission did not differ among the various groups defined by the sepsis classification system (sepsis = 454 +/- 79 ng/ml; severe sepsis = 359 +/- 54 ng/ml; septic shock = 371 +/- 53 ng/ml; P = 0.44). Furthermore, survivors of sepsis had a significantly higher CD4+ lymphocyte ATP content at the time of ICU admission than did nonsurvivors of sepsis (431 +/- 41 ng/mL vs. 266 +/- 53 ng/mL, respectively; P = 0.04).
  
  
  CONCLUSIONS
  The sepsis classification system that is currently used is not representative of the individual immune status as determined by measuring the CD4+ lymphocyte ATP content. Moreover, a lower CD4+ ATP content at the time of ICU admission is associated with a worse clinical outcome in those suffering from sepsis.
authors.affiliation: Department of Medicine, Washington University in St, Louis School of Medicine, 660 South Euclid, Campus Box 8052, St Louis, Missouri 63110, USA. kevinllawrence@yahoo.com
authors.forename: Kevin L
authors.initials: KL
authors.lastname: Lawrence
authors.forename: Patrick H
authors.initials: PH
authors.lastname: White
authors.forename: Gerald P
authors.initials: GP
authors.lastname: Morris
authors.forename: Jody
authors.initials: J
authors.lastname: Jennemann
authors.forename: Donna L
authors.initials: DL
authors.lastname: Phelan
authors.forename: Richard S
authors.initials: RS
authors.lastname: Hotchkiss
authors.forename: Marin H
authors.initials: MH
authors.lastname: Kollef
mesh_terms: D000255:Adenosine Triphosphate / Q000097:blood* / Q000276:immunology; D001800:Blood Specimen Collection; D015496:CD4-Positive T-Lymphocytes / Q000276:immunology* / Q000378:metabolism; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D008923:Missouri; D018805:Sepsis / Q000145:classification / Q000276:immunology* / Q000378:metabolism; D012720:Severity of Illness Index
chemical_list: D000255:Adenosine Triphosphate