ObjectiveTo investigate the predictive value of peripheral blood Th1/Th2 and Treg/Th17 cytokines on the short-term prognosis of patients with severe sepsis.

MethodsA total of 120 patients with severe sepsis admitted to Suzhou Hospital Affiliated to Anhui Medical University from April 2018 to April 2021 were enrolled as the study group, and 103 healthy examination people in the same period were selected as the control group.The levels of peripheral blood Th1/Th2 cytokinesγ-interferon (IFN-γ) and interleukin-4(IL-4) and Treg/Th17 cytokinestransforming growth factor β (TGF-β) and interleukin-17(IL-17) were detected and compared.All patients were followed up for 28 days, and they were divided into death group and survival group according to the survival status in the study group.The levels of peripheral blood IFN-γ, IL-4, TGF-β, IL-17, IFN-γ/IL-4 and TGF-β/IL-17 were compared in the death group and the survival group.The multivariate logistic regression analysis method was used to analyze the relationships between the levels of cytokines and the recent death of patients with severe sepsis.In addition, the receiver operating characteristic(ROC) curve was used to analyze the predictive value of levels of peripheral blood IFN-γ, IL-4, TGF-β, IL-17, IFN-γ/IL-4 and TGF-β/IL-17 on the recent death of patients with severe sepsis.

ResultsThe levels of peripheral blood IFN-γ, IL-4, TGF-β and IL-17 in the study group were higher than those of the control group(P < 0.01), but the IFN-γ/IL-4 and TGF-β/IL-17 in the study group were lower than those of the control group (P < 0.05).The 28 days mortality rate of patients was 25.00%.The levels of peripheral blood IFN-γ, IL-4, TGF-β and IL-17 in the death group were higher than those of the survival group(P < 0.01), but the IFN-γ/IL-4 and TGF-β/IL-17 in the death group were lower than those of the survival group(P < 0.01).Age Increases, high APACHE-Ⅱ score and SOFA score, and high levels of serum creatinine, IFN-γ, IL-4, TGF-β, IL-1 were the risk factors affecting the recent death of patients (P < 0.05), and decrease of IFN-γ/IL-4 and TGF-β/IL-17 ratio were the protective factor for the recent death of patients(P < 0.05 to P < 0.01).The sensitivity of the levels of peripheral blood IFN-γ, IL-4, TGF-β and IL-17 in combined prediction the death within 28 days of hospitalization in severe sepsis patients was higher than that of single prediction, and the AUC was higher than that of single prediction(P < 0.01).The sensitivity of IFN-γ/IL-4 combined with TGF-β/IL-17 in predicting of recent death in patients with severe sepsis was higher than that of single prediction, and AUC was higher than that of single prediction(P < 0.01).

ConclusionsThe levels of peripheral blood IFN-γ, IL-4, TGF-β and IL-17 of patients with severe sepsis are abnormally increased, but IFN-γ/IL-4 and TGF-β/IL-17 are reduced, and the changes of levels of them are related to the short-term prognosis of patients, which are the influence factors of patients' death within 28 days after hospitalization, and they all have a certain predictive values for patients' death within 28 days, but the combined prediction value of the four indicators is higher.