VALUE OF THE DYNAMIC MONITORING OF IMMUNE-RELATED INDEXES WHEN EVALUATING IMMUNE FUNCTIONS AND PREDICTING THE SEVERITY AND OUTCOMES OF CRITICALLY ILL PATIENTS IN THE ICU

Objective: To explore the value of the dynamic monitoring of immune-related indexes when evaluating immune functions and predicting the severity and outcomes of critically ill patients in the ICU. Methods: The clinical data of the patients admitted to the emergency ICU department of our hospital from February 2016 to September 2016 were retrospectively analysed, and 50 patients who met the study criteria were screened. According to the 30-day mortality and infection data during hospitalization, 16 cases were placed in the death group, 34 cases in the survival group, 35 cases in the infection group and 15 cases in the non-infection group. Fasting venous blood samples were collected on the 3rd, 6th and 9th days after admission to the emergency ICU department. The serum levels of interleukin (IL)-6, IL-10, procalcitonin (PCT), CD8+T cells, helper CD4+T cells, and high sensitivity C-reactive protein (hs-CRP), the CD4+T/CD8+T ratio, and changes in the levels of humoral immune-associated globulins (IgA, IgG, and IgM) were measured. Receiver operating characteristic (ROC) curves were drawn to evaluate the prognostic value of these measurements the patients. Results: Within 24 h after admission, the sequential organ failure assessment (SOFA) and acute physiology and chronic health evaluation (APACHE) scores in the death group were significantly higher than those in the survival group (p < 0.05). On the 3rd day after admission, the levels of serum IgM, IgA, and CD8+ T in the death group were significantly higher than those in the survival group (p<0.05). On the 6th day after admission, the level of serum IL-10 in the death group was significantly higher than that in the survival group (p<0.05). On the 9th day after admission, the level of serum PCT in the death group was significantly higher than that in the survival group, whereas the serum IL-6, IgM, IgA and CD8+T cell levels were significantly lower in the death group than in the survival group (p<0.05). Moreover, the level of serum IL-6 in the infection group was significantly higher than that in the non-infection group (p<0.05). There were no significant differences in any of the other examined biochemical indexes between the two groups at other time points (p>0.05). After drawing the ROC curves, the APACHE and SOFA scores within 24 h of admission to the ICU, serum IL-10 levels on day 6, serum PCT levels on day 9, and the specificity and sensitivity of serum CD8+T cells on day 3 were higher, and the areas under the ROC curve were larger for these indexes. Therefore, these factors can be used to better predict the prognosis of critically ill patients in the ICU (p<0.05). Conclusion: The dynamic monitoring of immune-related indexes can be used to evaluate the immune functions of critically ill patients in the ICU and to predict the severity and outcomes of disease. The levels of (CD+T)-T-8 cells, serum IL-10, and PCT, and the APACHE and SOFA scores within 24 h after admission have high value for the diagnosis of adverse outcomes in critically ill patients and are important markers for determining the prognosis of critically ill patients.