Association between lymphocyte expression of the apoptotic receptor Fas and pain in critically ill patients
Bibliographic record
Abstract
Objective: Lymphocyte apoptosis in critical illness is associated with immunosuppression. We explored for the first time the associations between pain ratings and expression of the apoptotic receptor Fas on B and T cells in critically ill patients and the potential mediating effects of adrenocorticotropic hormone (ACTH), cortisol, and substance P (SP). Design: This is an exploratory correlational study with repeated measurements (14 days follow-up) and cross-sectional comparisons. Setting: This study was conducted in a state hospital in the metropolitan area of Athens, Greece. Participants: The participants were 36 consecutive critically ill patients and 36 matched controls. Outcome measures: Pain measured by the self-reported numeric rating scale [NRS], the behavioral pain scale, and the pain assessment scale was the primary outcome measure. Flow cytometry (Fas), electrochemiluminescence (ACTH and cortisol) and enzyme-linked immunosorbent assay (SP) were used. Mixed linear models for repeated measurements and bivariable associations at discrete time points were employed. Results: Significant pain at rest was noted. Pain ratings associated with Fas expression on cytotoxic T cells ( P =0.041) and B cells ( P =0.005), even after adjustment for a number of clinical treatment factors ( P =0.006 and P =0.052, respectively). On the day that more patients were able to communicate, Fas on B cells ( r =0.897, P =0.029) and cytotoxic T cells ( r =0.832; P =0.037) associated with NRS ratings. Associations between pain ratings and ACTH serum levels were noted ( P <0.05). When stress neuropeptide levels were added to the model, the statistical significance of the associations between pain ratings and Fas expression was attenuated ( P =0.052–0.063), suggesting that stress neuropeptides may partially mediate the association. Conclusion: Preliminary evidence for the association between pain and lymphocyte apoptotic susceptibility is provided. The role of pain management in maintaining immunocompetence in critical illness is worth exploring. Keywords: lymphocyte apoptosis, pain, critical illness, adrenocorticotropic hormone, cortisol, substance P
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.012 | 0.377 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".