ABSTRACT
Sepsis is one of the most frequent complications in the surgical patient and one of the leading causes of mortality in intensive care units. Recent studies have shown that sepsis is a bimodal entity. The first phase is characterized by the systemic release of pro-inflammatory cytokines such as TNF-alpha, IL-1 and IL-8 and by activation of the complement and coagulation cascades. In the second phase, anti-inflammatory mediators such as TGF-beta, IL-10, Prostaglanding E[2] may be released in an effort to counteract ongoing inflammation. Depending whether pro or anti-inflammatory responses predominates, some people referred to a systemic inflammatory response syndrome [SIRS] and a compensatory anti-inflammatory response syndrome [CARS]. This work aimed to study selected immune markers [which represent both innate and adaptive immune systems] on the surface of white blood cells of critically ill patients who are expected to stay for a relatively long period in the ICU to identify a marker that can predict the development of nosocomial sepsis in the ICU [NICUS] patients while their stay in the ICU, a marker that can predict the development of mortality among ICU patients and a marker that can separate septic from non septic patients immediately alter admission to the ICU. Several markers which are expressed on the surface of different categories of white blood cells were measured CD 14 and HLA. DR for monocytes, CD16b CD11b and CD64 for PMNS and CD69, HLA. DR. CD57 and CD28 for lymphocytes. A total of 105 patients were admitted to the ICU department and differentiated into two groups 36 septic patients and 69 control [without sepsis]; with time observation of second group, 25 patients develop sepsis in the ICU [Nosco-mial ICU sepsis] consider as third group. A moderate prediction of noscomial sepsis can he expressed by CD 14 lower than 1602 molecule of CD64 pie cell of neutrophil is a good indicator of noscomial sepsis in critically ill patients. The absolute number of CD64 per cell of neutrophil [high than 1727 molecule/cell] identify septic patients on admission of ICU, while the positive lymphocytes higher than 31% can moderately identify septic patients early on ICU admission. The absolute number of CD64 on PMNs with a lower level than 2222 molecule/cell in first day of ICU admission showed a very good ability to predict 28[th] day mortality. Surface markers present on leukocytes could be used to diagnose early sepsis and predict hospital outcome. Measurement of mCD14 in patients in the ICU could be informative about the development of sepsis