CD4 + CD25 + CD127 high cells as a negative predictor of multiple organ failure in acute pancreatitis.
It has been suggested that severity of the immune response induced by immune cells is associated with morbidity and mortality from acute pancreatitis. The authors investigated and evaluated the relationship between distinct peripheral lymphocyte subsets at admission and clinical outcome prior to hospital discharge so as to find a predictor to the prognosis of acute pancreatitis in lymphocyte profile.



Lymphocyte subsets in admission peripheral venous blood were tested through flow cytometry on 48 patients with acute pancreatitis. Clinical data was recorded as well. The primary observational outcomes were multiple organ failure (MOF) and infection.



There was a significant difference in natural killer cells between two subgroups sorted by the presence or absence of infection (25.5 ± 4.47 [95% CI 14.4, 36.6]vs14.8 ± 7.62 [95% CI 12.5,1 7.1]p= 0.021). Patients who developed MOF had lower CD4 + CD25 + CD127high(4.49 ± 1.5 (MOF) [95% CI 3.83, 5.16]vs6.57 ± 2.65 (non-MOF) [95% CI 5.5, 7.64]p= 0.002) and higher CD127low/high cell counts (1.35 ± 0.66 [95% CI 1.06, 1.65]vs0.97 ± 0.44 [95% CI 0.79, 1.15]p= 0.02). MOF patients were significantly older (55 ± 14.58 [95% CI 48.49,61.42]vs46 ± 15.59 [95% CI 39.39,51.99]p= 0.04), and had higher Acute Physiology and Chronic Health Evaluation IIscores (7 ± 3.66 [95% CI 5.5,7.64]vs4 ± 2.89 [95% CI 2.45,4.78]p= 0.001) and C reactive protein (100.53 ± 94.38 [95% CI 58.69,142.48]vs50.8 ± 59.2 [95% CI 26.88,74.71]p= 0.04). In a multivariate regression model, only CD4 + CD25 + CD127highcell was a significant predictor of non-MOF. For the detection of non-MOF, CD4 + CD25 + CD127highcell generated a receiver operating characteristic (ROC) curve with an area under the curve of 0.74.



CD4 + CD25 + CD127highcell at early phase of acute pancreatitis yields good specificity in detecting non-MOF at a suggested cutoff value 6.41%. Patients with fewer natural killer cells may be at risk in developing secondary infection.
Department of Emergency Surgery, The Second Affiliated Hospital of Anhui Medical University, 678 Furong Road, Hefei, 230601 Anhui Province People's Republic of China.
Wei
W
Wang
Department of Emergency Surgery, The Second Affiliated Hospital of Anhui Medical University, 678 Furong Road, Hefei, 230601 Anhui Province People's Republic of China.
He-Ping
HP
Xiang
Hematology department, The Second Affiliated Hospital of Anhui Medical University, Hefei, 230601 Anhui Province People's Republic of China.
Hui-Ping
HP
Wang
Central lab of the First Affiliated Hospital of Anhui Medical University, Hefei, 230022 Anhui Province People's Republic of China.
Li-Xin
LX
Zhu
Department of General Surgery, The Second Affiliated Hospital of Anhui Medical University, Hefei, 230601 Anhui Province People's Republic of China.
Xiao-Ping
XP
Geng
D018806:APACHE; D000208:Acute Disease; D000328:Adult; D000368:Aged; D003661:Decision Support Techniques; D005260:Female; D005434:Flow Cytometry / Q000379:methods; D006801:Humans; D016015:Logistic Models; D018655:Lymphocyte Count / Q000379:methods; D008214:Lymphocytes / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D063305:Organ Dysfunction Scores; D010195:Pancreatitis / Q000145:classification* / Q000175:diagnosis* / Q000378:metabolism; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D013601:T-Lymphocytes / Q000145:classification* / Q000276:immunology / Q000378:metabolism
Acute pancreatitis; CD4 + CD25 + CD127high cell; Multiple organ failure; Natural killer cells; Prognosis; Regulatory T cell