title: Early levels in blood of immunoglobulin M and natural killer cells predict outcome in nonseptic critically ill patients.
abstract: OBJECTIVE
  Critical illness results in derangements of all components of the immune response. Nonetheless, most of the efforts evaluating immune status in critically ill patients have been done in the field of sepsis. Here we have evaluated the immunity status at intensive care unit (ICU) admission in a cohort of nonseptic critically ill patients and its influence on their outcome.
  
  
  METHODS
  Ninety patients 18 years and older admitted to our ICU were studied for levels of immunoglobulin (Ig) G, IgM, IgA, CD3(+)CD4(+) T cells, CD3(+)CD8(+) T cells, B cells, natural killer (NK) cells, and C3 and C4 complement factors in peripheral blood in the next 24 hours after admission to the ICU. Patients with infection, sepsis, immunodeficiency, or concomitant immunosuppressive therapy were excluded.
  
  
  RESULTS
  Levels of IgM, CD3(+) T cells, CD4(+) T cells, CD8(+) T cells, and B lymphocytes correlated inversely with age. In turn, levels of CD3(+) T cells, CD4(+) T cells, CD8(+) T cells, and C3 factor of the complement system correlated inversely with Acute Physiology and Chronic Health Evaluation II score. Multivariate Cox regression analysis censored at 28 days evidenced that levels of IgM played a protective role, whereas levels of NK cells behaved as a risk factor for mortality. Kaplan-Meier curves showed a cutoff of 58 mg/dL for IgM and 140 cells/mm(3) for NK cells.
  
  
  CONCLUSIONS
  In conclusion, our results demonstrate that IgM plays a protective role in critically ill patients with no sepsis, whereas NK cell counts seem to play a deleterious one. Aging and severity at admission affect levels of key factors of the immune system in the blood of these patients.
authors: Critical Care Medicine Service, Hospital Clínico Universitario SACYL/SEMICYUC, Avda Ramón y Cajal 3, Valladolid, Spain; Laboratorio de Investigación Médica Avanzada (IMAV), Unidad de Investigación Biomédica, Hospital Clínico Universitario SACYL, Avda Ramón y Cajal 3, Valladolid, Spain. Electronic address: dandaluz@saludcastillayleon.es.
authors: David
authors: D
authors: Andaluz-Ojeda
authors: Verónica
authors: V
authors: Iglesias
authors: Felipe
authors: F
authors: Bobillo
authors: Mercedes
authors: M
authors: Nocito
authors: Ana M
authors: AM
authors: Loma
authors: Concepción
authors: C
authors: Nieto
authors: Epifanio
authors: E
authors: Ramos
authors: Francisco
authors: F
authors: Gandía
authors: Lucía
authors: L
authors: Rico
authors: Jesús F
authors: JF
authors: Bermejo-Martin
mesh_terms: D018806:APACHE; D000367:Age Factors; D000368:Aged; D015415:Biomarkers / Q000097:blood; D015897:Comorbidity; D003176:Complement C3 / Q000032:analysis; D003181:Complement C4 / Q000032:analysis; D016638:Critical Illness; D005260:Female; D006801:Humans; D007070:Immunoglobulin A / Q000097:blood; D007074:Immunoglobulin G / Q000097:blood; D007075:Immunoglobulin M / Q000097:blood*; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007694:Killer Cells, Natural / Q000276:immunology*; D018655:Lymphocyte Count; D016131:Lymphocyte Subsets; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D013997:Time Factors
chemical_list: D015415:Biomarkers; D003176:Complement C3; D003181:Complement C4; D007070:Immunoglobulin A; D007074:Immunoglobulin G; D007075:Immunoglobulin M
keywords: APACHE II; Acute Physiology and Chronic Health Evaluation II; COPD; CT; CVA; Critical; IgM; Immunity; NK; Outcome; cerebrovascular accident; chronic obstructive pulmonary disease; craneoencephalic trauma