Prognostic significance of lymphocyte PD-1 expression in combination with clinical scoring systems in patients with liver cirrhosis complicated by sepsis.

BACKGROUND

Liver cirrhosis complicated by sepsis is associated with significant immune dysfunction and high mortality rates. Programmed cell death protein 1 (PD-1) expression on lymphocytes has been implicated in immune exhaustion, but its prognostic significance in this population remains unclear.

OBJECTIVE

This study aimed to evaluate the prognostic value of lymphocyte PD-1 expression in combination with clinical scoring systems, such as the Child-Pugh score and chronic liver failure-sequential organ failure assessment (CLIF-SOFA), for predicting disease severity and 28-day mortality in patients with cirrhosis complicated by sepsis.

METHODS

This prospective study included 86 patients with cirrhosis and sepsis admitted to Beijing You'an Hospital between June 2023 and May 1, 2024. Fresh whole blood was collected at enrollment, and peripheral blood mononuclear cells (PBMCs) were isolated for flow cytometric analysis of PD-1 expression on CD3+, CD4+, and CD8+ lymphocytes. Clinical parameters, scoring systems, and laboratory data were collected to assess their correlation with PD-1 expression and patient outcomes.

RESULTS

Of the 86 patients, 38 (44.2%) survived, while 48 (55.8%) died within 28 days. Non-survivors exhibited higher PD-1 expression on CD3+, CD4+, and CD8+ lymphocytes, as well as worse Child-Pugh and CLIF-SOFA scores (all p < 0.05). A significant positive correlation was observed between lymphocyte PD-1 expression and disease severity scores. Multivariate logistic regression analysis identified PD-1 expression on CD3+, CD4+, and CD8+ lymphocytes as independent predictors of 28-day mortality. Combining lymphocyte PD-1 expression with clinical scoring systems improved the predictive accuracy for septic shock and mortality.

CONCLUSION

Lymphocyte PD-1 expression is associated with disease severity and poor prognosis in patients with cirrhosis complicated by sepsis. Combining PD-1 expression with traditional scoring systems enhances risk stratification and may provide a more comprehensive tool for predicting outcomes in this high-risk population.