• Charalambos Gogos, Antigone Kotsaki, Aimilia Pelekanou, George Giannikopoulos, Ilia Vaki, Panagiota Maravitsa, Stephanos Adamis, Zoi Alexiou, George Andrianopoulos, Anastasia Antonopoulou, Sofia Athanassia, Fotini Baziaka, Aikaterini Charalambous, Sofia Christodoulou, Ioanna Dimopoulou, Ioannis Floros, Efthymia Giannitsioti, Panagiotis Gkanas, Aikaterini Ioakeimidou, Kyriaki Kanellakopoulou, Niki Karabela, Vassiliki Karagianni, Ioannis Katsarolis, Georgia Kontopithari, Petros Kopterides, Ioannis Koutelidakis, Pantelis Koutoukas, Hariklia Kranidioti, Michalis Lignos, Konstantinos Louis, Korina Lymberopoulou, Efstratios Mainas, Androniki Marioli, Charalambos Massouras, Irini Mavrou, Margarita Mpalla, Martha Michalia, Heleni Mylona, Vassilios Mytas, Ilias Papanikolaou, Konstantinos Papanikolaou, Maria Patrani, Ioannis Perdios, Diamantis Plachouras, Aikaterini Pistiki, Konstantinos Protopapas, Kalliopi Rigaki, Vissaria Sakka, Monika Sartzi, Vassilios Skouras, Maria Souli, Aikaterini Spyridaki, Ioannis Strouvalis, Thomas Tsaganos, George Zografos, Konstantinos Mandragos, Phylis Klouva-Molyvdas, Nina Maggina, Helen Giamarellou, Apostolos Armaganidis, and Evangelos J Giamarellos-Bourboulis.
• 1st Department of Internal Medicine, University of Patras, Medical School, 26504 Rio, Greece. cgogos@med.upatras.gr
• Crit Care. 2010 Jan 1;14(3):R96.

IntroductionAlthough major changes of the immune system have been described in sepsis, it has never been studied whether these may differ in relation to the type of underlying infection or not. This was studied for the first time.MethodsThe statuses of the innate and adaptive immune systems were prospectively compared in 505 patients. Whole blood was sampled within less than 24 hours of advent of sepsis; white blood cells were stained with monoclonal antibodies and analyzed though a flow cytometer.ResultsExpression of HLA-DR was significantly decreased among patients with severe sepsis/shock due to acute pyelonephritis and intraabdominal infections compared with sepsis. The rate of apoptosis of natural killer (NK) cells differed significantly among patients with severe sepsis/shock due to ventilator-associated pneumonia (VAP) and hospital-acquired pneumonia (HAP) compared with sepsis. The rate of apoptosis of NKT cells differed significantly among patients with severe sepsis/shock due to acute pyelonephritis, primary bacteremia and VAP/HAP compared with sepsis. Regarding adaptive immunity, absolute counts of CD4-lymphocytes were significantly decreased among patients with severe sepsis/shock due to community-acquired pneumonia (CAP) and intraabdominal infections compared with sepsis. Absolute counts of B-lymphocytes were significantly decreased among patients with severe sepsis/shock due to CAP compared with sepsis.ConclusionsMajor differences of the early statuses of the innate and adaptive immune systems exist between sepsis and severe sepsis/shock in relation to the underlying type of infection. These results may have a major impact on therapeutics.

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