{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T21:06:39Z","timestamp":1792789599708,"version":"4.5.0"},"reference-count":44,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2024,7,19]],"date-time":"2024-07-19T00:00:00Z","timestamp":1721347200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"University of Medicine, Pharmacy, Science, and Technology \u2018George Emil Palade\u2019 in T\u00e2rgu Mure\u0219","award":["10126\/17.12.2020"],"award-info":[{"award-number":["10126\/17.12.2020"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Sepsis involves a dysregulated host response, characterized by simultaneous immunosuppression and hyperinflammation. Initially, there is the release of pro-inflammatory factors and immune system dysfunction, followed by persistent immune paralysis leading to apoptosis. This study investigates sepsis-induced apoptosis and its pathways, by assessing changes in PD-1 and PD-L1 serum levels, CD4+ and CD8+ T cells, and Sequential Organ Failure Assessment (SOFA) and Acute Physiology and Chronic Health Evaluation (APACHE II) severity scores. Materials and Methods: This prospective, observational, single-centre study enrolled 87 sepsis patients admitted to the intensive care unit at the County Emergency Clinical Hospital in T\u00e2rgu Mure\u0219, Romania. We monitored the parameters on day 1 (the day sepsis or septic shock was diagnosed as per the Sepsis-3 Consensus) and day 5. Results: Our study found a statistically significant variation in the SOFA score for the entirety of the patients between the studied days (p = 0.001), as well as for the studied patient groups: sepsis, septic shock, survivors, and non-survivors (p = 0.001, p = 0.003, p = 0.01, p = 0.03). On day 1, we found statistically significant correlations between CD8+ cells and PD-1 (p = 0.02) and PD-L1 (p = 0.04), CD4+ and CD8+ cells (p &lt; 0.0001), SOFA and APACHE II scores (p &lt; 0.0001), and SOFA and APACHE II scores and PD-L1 (p = 0.001 and p = 0.01). On day 5, we found statistically significant correlations between CD4+ and CD8+ cells and PD-L1 (p = 0.03 and p = 0.0099), CD4+ and CD8+ cells (p &lt; 0.0001), and SOFA and APACHE II scores (p &lt; 0.0001). Conclusions: The reduction in Th CD4+ and Tc CD8+ lymphocyte subpopulations were evident from day 1, indicating that apoptosis is a crucial factor in the progression of sepsis and septic shock. The increased expression of the PD-1\/PD-L1 axis impairs costimulatory signalling, leading to diminished T cell responses and lymphopenia, thereby increasing the susceptibility to nosocomial infections.<\/jats:p>","DOI":"10.3390\/medicina60071174","type":"journal-article","created":{"date-parts":[[2024,7,19]],"date-time":"2024-07-19T14:16:38Z","timestamp":1721398598000},"page":"1174","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["The Role of Programmed Cell Death 1\/Programmed Death Ligand 1 (PD-1\/PD-L1) Axis in Sepsis-Induced Apoptosis"],"prefix":"10.3390","volume":"60","author":[{"given":"Oana","family":"Coman","sequence":"first","affiliation":[{"name":"Department of Simulation Applied in Medicine, University of Medicine, Pharmacy, Science and Technology \u201cGeorge Emil Palade\u201d, 540142 Targu Mures, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bianca-Liana","family":"Grigorescu","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology and Intensive Therapy, University of Medicine, Pharmacy, Science and Technology \u201cGeorge Emil Palade\u201d, 540142 Targu Mures, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9798-1594","authenticated-orcid":false,"given":"Adina","family":"Hu\u021banu","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine, University of Medicine, Pharmacy, Science and Technology \u201cGeorge Emil Palade\u201d, 540142 Targu Mures, Romania"},{"name":"Center for Advanced Medical and Pharmaceutical Research, Immunology, University of Medicine, Pharmacy, Science and Technology \u201cGeorge Emil Palade\u201d, 540142 Targu Mures, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9473-0287","authenticated-orcid":false,"given":"Anca","family":"Bac\u00e2rea","sequence":"additional","affiliation":[{"name":"Department of Pathophysiology, University of Medicine, Pharmacy, Science and Technology \u201cGeorge Emil Palade\u201d, 540142 Targu Mures, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anca Meda","family":"V\u0103sie\u0219iu","sequence":"additional","affiliation":[{"name":"Department of Infectious Disease, University of Medicine, Pharmacy, Science and Technology \u201cGeorge Emil Palade\u201d, 540142 Targu Mures, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raluca \u0218tefania","family":"Fodor","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology and Intensive Therapy, University of Medicine, Pharmacy, Science and Technology \u201cGeorge Emil Palade\u201d, 540142 Targu Mures, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Florin","family":"Stoica","sequence":"additional","affiliation":[{"name":"Clinic of Internal Medicine II, Emergency County Hospital, 540136 Targu Mures, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leonard","family":"Azamfirei","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology and Intensive Therapy, University of Medicine, Pharmacy, Science and Technology \u201cGeorge Emil Palade\u201d, 540142 Targu Mures, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,7,19]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"200","DOI":"10.1016\/S0140-6736(19)32989-7","article-title":"Global, regional, and national sepsis incidence and mortality, 1990\u20132017: Analysis for the Global Burden of Disease Study","volume":"395","author":"Rudd","year":"2020","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Nedeva, C., Menassa, J., and Puthalakath, H. 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