Low-dose glucocorticoids combined with continuous blood purification in sepsis: A comparison of inflammatory factors and T lymphocyte subsets

Abstract: Background: Sepsis is an infection induced systemic inflammatory response syndrome with poor prognosis mainly attributed to excessive inflammation and immune dysfunction. Continuous blood purification (CBP) is a core treatment and low dose glucocorticoids exert anti inflammatory and immunoregulatory effects. However, whether low-dose glucocorticoids combined with early CBP is associated with more favorable inflammatory, immune and short-term clinical outcomes than CBP alone remains unclear. Objectives: To evaluate the association of low-dose hydrocortisone combined with early CBP, compared with CBP alone, with inflammatory factors, T lymphocyte subsets and short-term prognosis in sepsis patients. Methods: A total of 120 sepsis patients were included in a retrospective 1:1 matched cohort analysis, including 60 patients in the CBP-alone cohort and 60 patients in the LD-GCs + CBP cohort, as identified from routinely recorded clinical data. Inflammatory factors, T lymphocyte subsets, HLA DR, HPA axis function and clinical outcomes were evaluated. Results: The LD-GCs + CBP group showed lower 28-day mortality, shorter ICU stay and lower septic shock incidence than the CBP-alone group (P<0.05). Proinflammatory factors were lower, anti inflammatory IL 10 higher and immune function better preserved (P<0.05). After treatment, CD3+, the CD4+/CD8+ ratio and HLA-DR were significantly higher in the LD-GCs + CBP group than in the CBP-alone group (P<0.05), whereas sCD163 was significantly lower (P<0.05). Conclusion: Low-dose hydrocortisone combined with early CBP was associated with attenuated inflammatory responses, more favorable immune marker changes and improved short-term outcomes in this cohort, with manageable adverse events. These findings require confirmation in larger multicenter studies.