Journal of Southern Medical University ›› 2026, Vol. 46 ›› Issue (1): 6-22.doi: 10.12122/j.issn.1673-4254.2026.01.02

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Identification of immune status subtypes and prognostic analysis of septic patients based on Th1/Th2 cytokine assays

Tong SHA1(), Wenyan WANG2(), Jiabin XUAN1(), Jie WU1, Nengxian SHI1, Jin HE1, Hongbin HU1(), Yaoyuan ZHANG1()   

  1. 1.Department of Critical Care Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
    2.Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu 610041, China
  • Received:2025-03-05 Accepted:2025-07-13 Online:2026-01-20 Published:2026-01-16
  • Contact: Hongbin HU, Yaoyuan ZHANG E-mail:shatong_smu@163.com;wwy9438@gmail.com;798524682@qq.com;hobewoos@163.com;243204661@qq.com
  • About author:First author contact:aThese authors contributed equally to this work and should be deemed as co-first authors.
    共同第一作者
  • Supported by:
    Supported by National Natural Science Foundation of China(8230241);国家自然科学基金(8230241);Guangzhou Science and Technology Program(2025A04J4187);广州市科学技术局青年博士“启航”项目(2025A04J4187)

Abstract:

Objective Sepsis patients exhibit diverse immune states, making it crucial to identify subtypes with distinct inflammatory profiles through Th1/Th2 cytokine data for personalized treatment and improved prognosis. Methods We retrieved data from sepsis patients who underwent Th1/Th2 cytokine testing in Nanfang Hospital, Southern Medical University from June 1, 2020, to February 1, 2022. An unsupervised K-means clustering method classified participants based on Th1/Th2 cytokine levels, with the primary outcome being the 7-day mortality rate post-ICU admission. Cox proportional hazards and Restricted Mean Survival Time (RMST) analyses were utilized to explore survival outcomes. Results A total of 321 sepsis patients were included. IL-6 (HR 1.69, 95%CI: 1.22, 2.34) and IL-10 (HR 1.81, 95% CI: 1.37, 2.40) emerged as independent predictors of 7-day mortality. Unsupervised K-means clustering revealed 3 inflammatory/immune subgroups: Cluster 1 (n=166, low inflammatory response), Cluster 2 (n=99, moderate inflammatory response with immune suppression), and Cluster 3 (n=56, strong inflammatory and immune suppression). Compared to Cluster 1, Clusters 2 and 3 had higher 7-day mortality risks (14.4% vs 23.2%, HR=4.30, 95% CI: 1.51-12.26; 14.4% vs 35.7%, HR=7.32, 95% CI: 2.57-20.79). Conclusion Septic patients in a protective immune response state (Cluster 1) exhibit better short-term prognoses, suggesting the importance of understanding inflammatory/immune states for precise treatment and improved outcomes.

Key words: Th1/Th2 cytokines, sepsis prognosis, K-means clustering, inflammatory/immune states