Relationship between changes in cellular immune function and rehospitalization rate in elderly patients / 中华老年医学杂志

ABSTRACT

Objective To observe the differences in T-lymphocyte subsets between patients with sepsis,non-sepsis and healthy controls with different ages,and to investigate the effect of cellular immune function on readmission rate.Methods The 337 patients with sepsis,350 patients with non-sepsis and 141 healthy controls were enrolled in this prospective study from general department and intensive care unit(ICU)of emergency department in Beijing Chaoyang Hospital during May 2017 to April 2018.The effects of ages on T lymphocyte subsets and acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ)and the effects of T lymphocyte subsets and APACHE Ⅱ on 30-day rehospitalization rate were comparatively studied.Results In patients with non-sepsis,the values of CD3+T,CD4+T,CD8+ T,natural killer(NK)cell count were lower in elderly group than in the non-elderlygroup(956.0±85.8)×10-6/L vs.(1363.3±46.7)×10 6/L,(647.3±59.9)×10-6/L vs.(875.8±33.4) × 10-6/L,(288.9± 31.1)× 10-6/L vs.(451.2±21.2)× 10-6/L and (14.5±0.64)％vs.(15.4±0.6)％,respectively,P＜0.01.In patients with sepsis group,the values of CD3+ T,CD4+T,NK cells count were decreased and APACHE Ⅱ were increased in the elderly group as compared with the non-elderly group.The 30-day readmission rate was higher in elderly patients than in the non-elderly patients(74 cases vs.39 cases,P ＜0.01).Compared with the non-elderly patients,the elderly patients had decreased values of CD3+ T,CD4+ T,CD8+ T,NK cells,CD4+/CD8+ cell count and an increased APACHE Ⅱ (P ＜0.05).Conclusions The cellular immune function is decreased in elderly patients,which is more obvious in elderly patients with sepsis.Age,CD3+ T,CD4+ T,CD8+T and APACHE Ⅱ could be used as an independent predictor for 30 day readmission rate.