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Objective:Taking emergency department (ED) as a starting point, to analyze the epidemiological characteristics and mortality risk factors of sepsis, and to provide evidences for ED to carry out the strategy of "three early and two lower" for sepsis.Methods:Based on the ED and inpatient medical record management information platform of Tianjin Medical University Gernal Hospital, adult ED patients with sepsis from January 1, 2017 to December 31, 2020 were included according to the third international consensus definitions for sepsis and septic shock in 2016 and the consensus of Chinese experts on early prevention and blocking of sepsis in 2020. The epidemiological characteristics of patients were retrospectively analyzed. Chi-square test was used to compare the difference of age, sex, hospitalization times, length of stay, hospitalization cost and infection location between dead patients and survival patients, and a stepwise logistic regression model was used to analyze the influencing factors of mortality in hospitalized patients with ED sepsis.Results:A total of 7 494 patients with sepsis in ED were included in this study, and the annual and monthly component ratios varied from 3.8‰ to 6.1‰ and 2.0‰ to 9.0‰, respectively. The main characteristics of patients with sepsis in ED were as follows: 40-69 years old (46.0%), male (59.0%), mostly diagnosed with sepsis (96.8%), mainly treated with urban health insurance (59.6%), and ED diagnosis and treatment fees of 2 000-8 000 Yuan (51.1%). The mortality of hospitalized patients with ED sepsis was 24.4% and that of hospitalized patients with septic shock was 28.8%. The main characteristics of hospitalized patients with ED sepsis were as follows: most of them were male (56.2%) patients over 70 years old (56.0%), most of them were diagnosed with sepsis (94.0%) and hospitalized for the first time (76.0%), the median hospitalization time was 15 d, most of them were hospitalized under urban health insurance (65.2%), and the median hospitalization fees was 47 000 Yuan. The risk factors of death were influenced by age and length of stay. Patients aged 70 years or older had a higher risk of death than those aged from 18 to 39 years, and patients with a length of stay of more than 7 d had a lower risk of death than those with a length of stay of shorter than 7 d. The primary infection focus were mainly respiratory and urinary systems, while the death rate of patients with hematological and abdominal infections was relatively high, and the difference was statistically significant ( P<0.01). Respiratory and abdominal infections were risk factors for death in patients with ED sepsis. Conclusions:The composition ratio of sepsis in ED patients is not regular in time, so vigilance of sepsis in elderly men and patients with respiratory system, blood system, urinary system and abdominal infections should be constantly raised. Patients with sepsis who are older, hospitalized more frequently, hospitalized for a shorter time, and infected in the respiratory system or abdomen have a higher risk of death.
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Objective To investigate the effect of co-expression of neuropilin-1(Nrp-1)and transforming growth factor-β(TGF-β)on regulatory T cell(Treg)-mediated immunosuppression. Methods CD4+CD25+Tregs were isolated from the spleens of male Balb/c mice. CD4+CD25+Tregs were blocked with various doses of Nrp-1 antibody(Ab-Nrp-1,0.5,5,10 μg/ml)for 24 hours with anti-CD3/CD28 and lipopolysaccharide(LPS)stimulation, and expression of Nrp-1 and TGF-βwas determined by flow cytometry. Meanwhile,CD4+CD25+Tregs were cultured with different doses of Ab-Nrp-1 for 1 hour,and co-cultured with CD4+CD25-T cell for 12,24 and 48 hours respectively,the proliferative activity of CD4+CD25-T cells was analyzed by microplate reader. Results Compared to control group,the expressions of Nrp-1 and TGF-β were significantly increased under anti-CD3/CD28 and LPS stimulation(both P<0.05),and treatment with Ab-Nrp-1 markedly inhibited the expression of TGF-β in a dose-dependent manner(P<0.05). The normal Treg had the potential to inhibit the proliferation of CD4+CD25-T cells(P<0.05),while various doses of Ab-Nrp-1 had the ability to reverse the immunosuppressive function of CD4+CD25+Treg in a dose-and time-dependent response manner,5μg/ml has the strongest ability,expecially after 24 hours. Conclusion Treg cell plays an important role in mediating immunosuppressive response via membrane associated TGF-β,and co-expression of Nrp-1 can markedly promote the immunosuppressive function.