Evaluation der Aktivierung von CD4+ T-Lymphozyten bei Patienten mit Sepsis und akutem Nierenversagen
Time course of CD4+ lymphocyte adenosine triphosphate in sepsis with and without acute kidney injury.
by Maria Brier
Date of Examination:2015-01-14
Date of issue:2014-12-19
Advisor:Prof. Dr. Michael Koziolek
Referee:PD Dr. Daniel Heise
Referee:Prof. Dr. Margarete Schön
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EnglishA lower CD4+ ATP content even at the time of ICU admission is associated with a worse clinical outcome in patients suffering from sepsis. Moreover, regulatory T cells seem to attenuate nephrotoxic effects in cisplatin nephrotoxicity. The aim of this study was to evaluate CD4+ ATP content in sepsis with or without acute kidney injury (AKI). The immune status of 33 patients with sepsis with and without AKI was prospectively determined on ICU admission as well as 48 and 96 hours thereafter by measuring the CD4+ lymphocyte adenosine triphosphate (ATP) content after mitogen stimulation in whole blood as well as urinary NGAL and correlated with clinical and laboratory data. Eleven septic patients without and 22 with AKI (AKIN 1: n=8, AKIN 2: n=4, AKIN 3: n=10) were included into the study. Time-courses of CD4+ ATP content did not significantly differ between patients with or without AKI (p=0.93) but for urinary NGAL with higher values in AKI (p<0.01; figure 1). Subgroup analysis revealed a significant difference with respect to different AKIN-stadiums (p<0.01; figure 2). Of the AKI-subgroup, 6 patients died and 1 underwent chronic dialysis at discharge. Twelve patients showed partial recovery of renal function and in 3 patients renal function recovered completely. Time-courses of CD4+ ATP content as well as urinary NGAL in AKI patients tended to differ with respect to renal outcome (p=0.056 and p=0.15, respectively; figure 3 and 4). Time-courses of CD4+ ATP content differ significantly with respect to AKIN stadium in septic patients with a tendency to be a prognostic marker of renal outcome.
Keywords: sepsis; acute kidney injury; CD4+ lymphocyte adenosine triphosphate