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The ratio of Th17/Treg cells as a risk indicator in early acute respiratory distress syndrome.

Yu ZX, Ji MS, Yan J, Cai Y, Liu J, Yang HF, Li Y, Jin ZC, Zheng JX - Crit Care (2015)

Bottom Line: Th17/Treg ratio was positively correlated with APACHE II score, SOFA score, and Lung Injury Score, while negatively correlated with PaO₂/FiO₂.Using a Th17/Treg ratio cutoff value of >0.79 to determine 28-day mortality, the sensitivity was 87.5% with 68.1% specificity.Finally, cumulative survival rates at 28-day follow-up also differed significantly between patients with Th17/Treg ratio >0.79 and ≤0.79 (P <0.001).

View Article: PubMed Central - PubMed

Affiliation: Department of Critical Care Medicine, The Affiliated People's Hospital, Jiangsu University, Zhenjiang, 212002, China. 9yzx@163.com.

ABSTRACT

Introduction: Recent studies have revealed that lung inflammation mediated by CD4+ T cells may contribute to the pathogenesis of acute respiratory distress syndrome (ARDS). The imbalance between CD4 + CD25 + Foxp3 + regulatory T (Treg) cells and T helper (Th)17 cells has been found in a number of different inflammation and autoimmune diseases, while the role of the Th17/Treg balance in ARDS remains largely unknown. The aim of this study was to investigate the Th17/Treg pattern and its impact on disease severity and outcomes in patients with ARDS.

Methods: This prospective, observational study enrolled 79 patients who fulfilled the Berlin definition of ARDS and 26 age- and sex-matched healthy controls. Circulation Th17 and Treg cell frequencies were analyzed by flow cytometry, and the expressions of Th17- and Treg-related cytokines in serum were measured by enzyme-linked immunosorbent assay (ELISA). Acute Physiologic and Chronic Health Evaluation (APACHE) II score, Sequential Organ Failure Assessment (SOFA) score, and the Lung Injury Score were also calculated at enrollment.

Results: Within 24 hours after the onset of ARDS, the changes of peripheral circulating Th17 and Treg cell frequencies gradually increased from mild to severe ARDS. Th17/Treg ratio was positively correlated with APACHE II score, SOFA score, and Lung Injury Score, while negatively correlated with PaO₂/FiO₂. The areas under the receiver operating characteristic (AUC) curves of Th17/Treg ratio for predicting 28-day mortality in ARDS patients was higher than that of APACHE II score, SOFA score, Lung injury score, as well as PaO2/FiO2. Using a Th17/Treg ratio cutoff value of >0.79 to determine 28-day mortality, the sensitivity was 87.5% with 68.1% specificity. Multivariate logistic regression showed Th17/Treg ratio >0.79 (odds ratio = 8.68, P = 0.002) was the independent predictor for 28-day mortality in patients with ARDS. Finally, cumulative survival rates at 28-day follow-up also differed significantly between patients with Th17/Treg ratio >0.79 and ≤0.79 (P <0.001).

Conclusions: The Th17/Treg imbalance favoring a Th17 shift represents a potential therapeutic target to alleviate lung injury and a novel risk indicator in patients with early ARDS.

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Relationship between ratio of Th17/Treg cells and acute physiology and chronic health evaluation (APACHE) II, sequential organ failure assessment (SOFA) or lung injury score, or arterial partial pressure of oxygen/inspired oxygen fraction (PaO2/FiO2) in patients with acute respiratory distress syndrome (ARDS). Spearman rank correlation was tested between variables. The ratio of Th17/Treg cells was positively correlated with APACHE II score (A), SOFA score (B), and lung injury score (C), while it was negatively correlated with PaO2/FiO2(D) in ARDS patients.
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Fig1: Relationship between ratio of Th17/Treg cells and acute physiology and chronic health evaluation (APACHE) II, sequential organ failure assessment (SOFA) or lung injury score, or arterial partial pressure of oxygen/inspired oxygen fraction (PaO2/FiO2) in patients with acute respiratory distress syndrome (ARDS). Spearman rank correlation was tested between variables. The ratio of Th17/Treg cells was positively correlated with APACHE II score (A), SOFA score (B), and lung injury score (C), while it was negatively correlated with PaO2/FiO2(D) in ARDS patients.

Mentions: Spearman correlation analysis of Th17/Treg ratio with APACHE II score, SOFA score, lung injury score, and PaO2/FiO2 in ARDS patients are displayed in Figure 1. For all patients with ARDS, the significantly positive and moderate correlations were found between Th17/Treg ratio and APACHE II score (r = 0.499, P <0.001), SOFA score (r = 0.363, P = 0.001), Lung injury score (r = 0.699, P <0.001), respectively. Furthermore, we noticed a negative and moderate correlation between the Th17/Treg ratio and PaO2/FiO2 (r = −0.670, P <0.001).Figure 1


The ratio of Th17/Treg cells as a risk indicator in early acute respiratory distress syndrome.

Yu ZX, Ji MS, Yan J, Cai Y, Liu J, Yang HF, Li Y, Jin ZC, Zheng JX - Crit Care (2015)

Relationship between ratio of Th17/Treg cells and acute physiology and chronic health evaluation (APACHE) II, sequential organ failure assessment (SOFA) or lung injury score, or arterial partial pressure of oxygen/inspired oxygen fraction (PaO2/FiO2) in patients with acute respiratory distress syndrome (ARDS). Spearman rank correlation was tested between variables. The ratio of Th17/Treg cells was positively correlated with APACHE II score (A), SOFA score (B), and lung injury score (C), while it was negatively correlated with PaO2/FiO2(D) in ARDS patients.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4355972&req=5

Fig1: Relationship between ratio of Th17/Treg cells and acute physiology and chronic health evaluation (APACHE) II, sequential organ failure assessment (SOFA) or lung injury score, or arterial partial pressure of oxygen/inspired oxygen fraction (PaO2/FiO2) in patients with acute respiratory distress syndrome (ARDS). Spearman rank correlation was tested between variables. The ratio of Th17/Treg cells was positively correlated with APACHE II score (A), SOFA score (B), and lung injury score (C), while it was negatively correlated with PaO2/FiO2(D) in ARDS patients.
Mentions: Spearman correlation analysis of Th17/Treg ratio with APACHE II score, SOFA score, lung injury score, and PaO2/FiO2 in ARDS patients are displayed in Figure 1. For all patients with ARDS, the significantly positive and moderate correlations were found between Th17/Treg ratio and APACHE II score (r = 0.499, P <0.001), SOFA score (r = 0.363, P = 0.001), Lung injury score (r = 0.699, P <0.001), respectively. Furthermore, we noticed a negative and moderate correlation between the Th17/Treg ratio and PaO2/FiO2 (r = −0.670, P <0.001).Figure 1

Bottom Line: Th17/Treg ratio was positively correlated with APACHE II score, SOFA score, and Lung Injury Score, while negatively correlated with PaO₂/FiO₂.Using a Th17/Treg ratio cutoff value of >0.79 to determine 28-day mortality, the sensitivity was 87.5% with 68.1% specificity.Finally, cumulative survival rates at 28-day follow-up also differed significantly between patients with Th17/Treg ratio >0.79 and ≤0.79 (P <0.001).

View Article: PubMed Central - PubMed

Affiliation: Department of Critical Care Medicine, The Affiliated People's Hospital, Jiangsu University, Zhenjiang, 212002, China. 9yzx@163.com.

ABSTRACT

Introduction: Recent studies have revealed that lung inflammation mediated by CD4+ T cells may contribute to the pathogenesis of acute respiratory distress syndrome (ARDS). The imbalance between CD4 + CD25 + Foxp3 + regulatory T (Treg) cells and T helper (Th)17 cells has been found in a number of different inflammation and autoimmune diseases, while the role of the Th17/Treg balance in ARDS remains largely unknown. The aim of this study was to investigate the Th17/Treg pattern and its impact on disease severity and outcomes in patients with ARDS.

Methods: This prospective, observational study enrolled 79 patients who fulfilled the Berlin definition of ARDS and 26 age- and sex-matched healthy controls. Circulation Th17 and Treg cell frequencies were analyzed by flow cytometry, and the expressions of Th17- and Treg-related cytokines in serum were measured by enzyme-linked immunosorbent assay (ELISA). Acute Physiologic and Chronic Health Evaluation (APACHE) II score, Sequential Organ Failure Assessment (SOFA) score, and the Lung Injury Score were also calculated at enrollment.

Results: Within 24 hours after the onset of ARDS, the changes of peripheral circulating Th17 and Treg cell frequencies gradually increased from mild to severe ARDS. Th17/Treg ratio was positively correlated with APACHE II score, SOFA score, and Lung Injury Score, while negatively correlated with PaO₂/FiO₂. The areas under the receiver operating characteristic (AUC) curves of Th17/Treg ratio for predicting 28-day mortality in ARDS patients was higher than that of APACHE II score, SOFA score, Lung injury score, as well as PaO2/FiO2. Using a Th17/Treg ratio cutoff value of >0.79 to determine 28-day mortality, the sensitivity was 87.5% with 68.1% specificity. Multivariate logistic regression showed Th17/Treg ratio >0.79 (odds ratio = 8.68, P = 0.002) was the independent predictor for 28-day mortality in patients with ARDS. Finally, cumulative survival rates at 28-day follow-up also differed significantly between patients with Th17/Treg ratio >0.79 and ≤0.79 (P <0.001).

Conclusions: The Th17/Treg imbalance favoring a Th17 shift represents a potential therapeutic target to alleviate lung injury and a novel risk indicator in patients with early ARDS.

Show MeSH
Related in: MedlinePlus