Latent profile analysis of the relationship between immune subtypes and glucocorticoid treatment response and prognosis in sepsis patients

Hong Dejiang; Zeng Wanting; Wang Wei; Hu Jinhao; Luo Lindi; Zhu Yingbo; Zhao Guangju

doi:10.3760/cma.j.cn501225-20251030-00451

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Article Navigation > CHINESE JOURNAL OF BURNS AND WOUNDS > > Accepted Manuscript

Hong Dejiang,Zeng Wanting,Wang Wei,et al.Latent profile analysis of the relationship between immune subtypes and glucocorticoid treatment response and prognosis in sepsis patients[J].Chin J Burns Wounds,2026,42(2):1-10.DOI: 10.3760/cma.j.cn501225-20251030-00451.

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Latent profile analysis of the relationship between immune subtypes and glucocorticoid treatment response and prognosis in sepsis patients

doi: 10.3760/cma.j.cn501225-20251030-00451

Emergency Department, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325015, China

Funds:

General Program of National Natural Science Foundation of China 82272202

Wenzhou High Level Innovation Team 2024R3002

More Information

Corresponding author: Zhao Guangju, Email: zgj_0523@126.com
Received Date: 2025-10-30
Available Online: 2026-01-28

Abstract

Abstract

Objective To explore the relationship between immune subtypes and glucocorticoid (GC) treatment response and prognosis in sepsis patients, so as to provide reference for immune typing and treatment of sepsis patients with burn and trauma. Methods The study was a retrospective cohort study. From January 1, 2021 to June 20, 2024, 499 sepsis patients were admitted to the emergency intensive care unit (EICU) of the First Affiliated Hospital of Wenzhou Medical University, including 304 males and 195 females, aged 67.0 (55.0, 75.0) years. The patients were divided into survival group (n=395) and death group (n=104) according to the death within 30 days after admission (hereinafter referred to as 30-day death). The clinical characteristics of the two groups of patients were compared, including age, body mass index, and other basic data, chronic lung, kidney, and liver diseases and other complications, sequential organ failure assessment (SOFA) score, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score, mechanical ventilation, and hemodialysis within 24 hours after admission, and the intravenous administration of GC within 48 hours of hospitalization, i.e., early GC treatment, and length of hospital stay. Based on the 11 immune indicators of all patients within 48 hours after admission, latent profile analysis (LPA) was used to identify the immune subtypes of patients. The clinical characteristics of patients with different immune subtypes were compared. The impact of immune subtypes on the 30-day death risk of patients and the impact of early GC treatment on the 30-day death risk of patients with different immune subtypes were evaluated. Results There were statistically significant differences in age, body mass index, SOFA score and APACHE Ⅱ score within 24 hours after admission, length of hospital stay, complications of chronic lung, kidney, and liver diseases, mechanical ventilation and hemodialysis within 24 hours after admission, and early GC treatment between patients in survival group and death group (with U values of 15 316.00, 24 534.00, 16 981.50, 12 242.00, and 40 685.00, respectively, χ² values of 7.66, 9.47, 5.17, 35.70, 20.76, and 6.57, respectively, P<0.05). LPA identified 4 immune subtypes, including 287 patients with immune stable type, 78 patients with immune activated type, 44 patients with immune suppressed type, and 90 patients with immune paralyzed type. There were statistically significant differences in SOFA score, APACHE Ⅱ score within 24 hours after admission, complication of chronic kidney disease, mechanical ventilation and hemodialysis within 24 hours after admission, and early GC treatment among the four immune subtypes of patients (with H values of 46.82 and 22.55, respectively, χ² values of 12.56, 17.77, 13.81, and 14.84, respectively, P<0.05). Among patients with immune paralyzed type, the 30-day death ratio of patients with early GC treatment was significantly higher than that of patients without early GC treatment (χ²=5.95, P<0.05). After adjusting for age, gender, body mass index, complications, SOFA score, and APACHE Ⅱ score, the 30-day death risk of patients with immune stable type was significantly lower than that of patients with immune paralyzed type (HR=0.53, with 95% CI of 0.33-0.86, P<0.05), and early GC treatment for patients with immune paralyzed type had a significant impact on the 30-day death risk (HR=2.92, with 95% CI of 1.16-7.32, P<0.05). Conclusions There are 4 immune subtypes in sepsis patients. Patients with different subtypes exhibit unique clinical features, prognoses, and varying responses to early GC treatment. Early GC treatment has a significant impact on the increased risk of death in patients with immune paralyzed type.
- Sepsis,
- Immunophenotyping,
- Glucocorticoids,
- Prognosis,
- Clinical characteristics,
- Latent profile analysis

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References(36)

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