Interleukin-10/lymphocyte ratio predicts mortality in severe septic patients

Xi Li; Zhiheng Xu; Xiaoqing Pang; Yongbo Huang; Baoxin Yang; Yuanyuan Yang; Kangxie Chen; Xiaoqing Liu; Pu Mao; Yimin Li

doi:10.1371/journal.pone.0179050

Interleukin-10/lymphocyte ratio predicts mortality in severe septic patients

PLoS One. 2017 Jun 19;12(6):e0179050. doi: 10.1371/journal.pone.0179050. eCollection 2017.

Authors

Xi Li^{1

2}, Zhiheng Xu^{1

3}, Xiaoqing Pang³, Yongbo Huang¹, Baoxin Yang¹, Yuanyuan Yang¹, Kangxie Chen¹, Xiaoqing Liu³, Pu Mao⁴, Yimin Li^{1

3}

Affiliations

¹ State Key Laboratory of Respiratory Disease, Guangzhou Medical University, Guangzhou, Guangdong, China.
² Intensive Care Unit, The People's Hospital Of Leshan, Sichuan, China.
³ Intensive Care Unit, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China.
⁴ Department of Infection Control, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China.

Abstract

Background: Immunosuppression is common even in the early stage of severe sepsis. Interleukin-10 (IL-10) secretion and lymphocyte exhaustion are the main features of sepsis-induced immunosuppression. However, the relationship between IL-10 and the lymphocyte is still unclear. We investigated if IL-10/lymphocyte ratio (IL10LCR) were associated with mortality in severe septic patients.

Methods: Adult patients with severe sepsis admitted to ICU of the First Affiliated Hospital of Guangzhou Medical University were identified from October 2012 to August 2013. Within 24 hours of ICU admission, peripheral whole blood was collected for the measurement of IL-10 using commercial multiplex bead-based assay kits and determination of lymphocyte count from laboratory data. The primary outcome was 28-day mortality.

Results: A total of 63 severe sepsis patients were identified. There were 20 (32%) patients died within 28 days. IL10LCR in non-survival patients was significantly higher than survival patients (median (IQR) 36.78 (12.34-79.63) ng/ml2 versus 11.01(5.41-27.50) ng/ml2, P = 0.002). Correlation analysis showed that IL10LCR was significantly correlated with APACHE II score (Spearman's rho = 0.424, P<0.001). The receiver operating characteristic (ROC) curves showed the area under the curve was 0.749 for IL10LCR level to predict 28-day mortality with sensitivity and specificity at 70.0% and 74.4%, respectively. At an optimal cutoff of 23.39ng/ml2, Kaplan-Meier curve showed survival in patients with IL10LCR level above 23.39ng/ml2 was significantly lower than in patients with IL10LCR level less than 23.39ng/ml2 (P = 0.001 by log-rank test).

Conclusion: IL10LCR level is significantly associated with the severity and outcome of severe septic patients. It may serve as a biomarker for sepsis-induced immunosuppression.

MeSH terms

APACHE
Adult
Aged
Area Under Curve
Female
Humans
Intensive Care Units
Interleukin-10 / blood*
Kaplan-Meier Estimate
Lymphocyte Count
Lymphocytes / cytology*
Male
Middle Aged
Proportional Hazards Models
ROC Curve
Sepsis / mortality*
Sepsis / pathology

Substances

Interleukin-10

Grants and funding

This study was supported by National Natural Science Foundation of China (Grant No. 81400060 to YH and 81490534 to YL); Natural Science Foundation of Guangdong Province, China (Grant No. 2015A030313480 to YL and 2015A030313456 to XQL); Guangzhou Healthcare Collaborative Innovation Major Project (Grant No. 201400000002 to YL) and Science and Technology Program of Guangzhou, China (Grant No. 2014Y-00065 to YL). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.