Open Access Highly Accessed Research

Early alterations of B cells in patients with septic shock

Jorge Monserrat1, Raul de Pablo12, David Diaz-Martín1, Manuel Rodríguez-Zapata13, Antonio de la Hera1, Alfredo Prieto1 and Melchor Alvarez-Mon14*

Author Affiliations

1 Laboratory of Immune System Diseases and Oncology, National Biotechnology Center (CNB-CSIC) Associated Unit, Department of Medicine, University of Alcalá, Madrid, Spain

2 Intensive Care Unit, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain

3 Internal Medicine Service, Hospital Universitario de Guadalajara, Guadalajara, Spain

4 Immune System Diseases and Oncology Service, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain

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Critical Care 2013, 17:R105  doi:10.1186/cc12750

Published: 30 May 2013

Abstract

Introduction

It has recently been proposed that B lymphocytes are involved in sepsis pathogenesis. The goal of this study is to investigate potential abnormalities in a subset distribution and activation of circulating B lymphocytes in patients with septic shock.

Methods

This observational prospective study was conducted in a medical-surgical ICU. All patients with septic shock were eligible for inclusion. B-cell phenotypes (CD19+CD69+, CD19+CD23+, CD19+CD5+, CD19+CD80, CD19+CD86+, CD19+CD40 and CD19+CD95+) were assessed by quantitative flow cytometry upon admission to the ICU and 3, 7, 14 and 28 d later.

Results

Fifty-two patients were included. Thirty-six healthy volunteers matched for age and sex were used as controls. The patients had lymphopenia that was maintained during 28 d of follow-up. In patients with septic shock who died, the percentage of CD19+CD23+ was lower during the 7 d of follow-up than it was in survival patients. Moreover, the percentage of CD80+ and CD95+ expression on B cells was higher in patients who died than in survivors. Receiver operating characteristic curve analysis showed that a CD19+CD23+ value of 64.6% at ICU admission enabled discrimination between survivors and nonsurvivors with a sensitivity of 90.9% and a specificity of 80.0% (P = 0.0001).

Conclusions

Patients with septic shock who survive and those who don't have different patterns of abnormalities in circulating B lymphocytes. At ICU admission, a low percentage of CD23+ and a high of CD80+ and CD95+ on B cells were associated with increased mortality of patients with septic shock. Moreover, a drop in circulating B cells persisted during 28 d of ICU follow-up.

Keywords:
Apoptosis; B cells; Flow cytometry; Lymphocyte; Lymphocyte activation; Phenotype; Sepsis; Septic shock