Expert consensus on the monitoring and treatment of sepsis-induced immunosuppression

Pei, Fei; Yao, Ren-qi; Ren, Chao; Bahrami, Soheyl; Billiar, Timothy R.; Chaudry, Irshad H.; Chen, Dechang; Chen, Xulin; Cui, Na; Fang, Xiangming; Kang, Yan; Li, Weiqin; Li, Wenxiong; Liang, Huaping; Lin, Hongyuan; Liu, Ke-Xuan; Lü, Ben; Lu, Zhongqiu; Maegele, Marc; Peng, Tianqing; Shang, You; Su, Lei; Sun, Bo; Wang, Changsong; Wang, Jian; Wang, Jianghuai; Wang, Ping; Xie, Jianfeng; Xie, Lixin; Zhang, Lina; Zingarelli, Basilia; Guan, Xiangdong; Wu, Jianfeng; Yao, Yong‐Ming

doi:10.1186/s40779-022-00430-y

Cited by 24 publications

(24 citation statements)

References 129 publications

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“…Immune cell surface markers, containing HLA‐DR, CD64, and PD‐1, are promising biomarkers for sepsis diagnosis and prognosis 19 . mHLA‐DR has been confirmed to be a reliable indicator for estimating sepsis‐induced immunesuppression 20,21 . The percentage of mHLA‐DR+ significantly decreased during sepsis, and the dynamic change in mHLA‐DR+ over time may be a reliable predictor for sepsis mortality 22 .…”

Section: Discussionmentioning

confidence: 99%

An integrative model with HLA‐DR, CD64, and PD‐1 for the diagnostic and prognostic evaluation of sepsis

Chen,

Chong,

Zhang

et al. 2024

Immunity Inflam & Disease

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BackgroundSepsis is a life‐threatening organ dysfunction caused by a dysregulated host response to infection and progressive immunosuppression with high mortality. HLA‐DR, CD64, and PD‐1 were assumed to be useful biomarkers for sepsis prediction. However, the ability of a combination of these biomarkers has not been clarified.MethodsAn observational case‐control study was conducted that included 30 sepsis patients, 30 critically ill patients without sepsis admitted to the intensive care unit (ICU), and 32 healthy individuals. The levels of HLA‐DR, CD64, and PD‐1 expression in peripheral blood immune cells and subsets was assayed on Days 1, 3, and 5, and the clinical information of patients was collected. We compared these biomarkers between groups and evaluated the predictive validity of single and combined biomarkers on sepsis mortality.ResultsThe results indicate that PD‐1 expression on CD4−CD8−T (PD‐1+CD4−CD8−T) (19.19% ± 10.78% vs. 9.88% ± 1.79%, p = .004) cells and neutrophil CD64 index (nCD64 index) (9.15 ± 5.46 vs. 5.33 ± 2.34, p = .001) of sepsis patients were significantly increased, and HLA‐DR expression on monocytes (mHLA‐DR+) was significantly reduced (13.26% ± 8.06% vs. 30.17% ± 21.42%, p = 2.54 × 10−4) compared with nonsepsis critically ill patients on the first day. Importantly, the expression of PD‐1+CD4−CD8−T (OR = 0.622, 95% CI = 0.423–0.916, p = .016) and mHLA‐DR+ (OR = 1.146, 95% CI = 1.014–1.295, p = .029) were significantly associated with sepsis mortality. For sepsis diagnosis, the mHLA‐DR+, PD‐1+CD4−CD8−T, and nCD64 index showed the moderate individual performance, and combinations of the three biomarkers achieved greater diagnostic value (AUC = 0.899, 95% CI = 0.792–0.962). When adding PCT into the combined model, the AUC increased to 0.936 (95% CI = 0.840–0.983). For sepsis mortality, combinations of PD‐1+CD4−CD8−T and mHLA‐DR+, have a good ability to predict the prognosis of sepsis patients, with an AUC = 0.921 (95% CI = 0.762–0.987).ConclusionThese findings indicate that the combinations of HLA‐DR, CD64, and PD‐1 outperformed each of the single indicator in diagnosis and predicting prognosis of sepsis.

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Section: Discussionmentioning

confidence: 99%

An integrative model with HLA‐DR, CD64, and PD‐1 for the diagnostic and prognostic evaluation of sepsis

Chen,

Chong,

Zhang

et al. 2024

Immunity Inflam & Disease

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“…Sepsis and sepsis-related mortality increased significantly with age [32][33][34]. Old age (≥65 years old) is one of the high-risk factors for immunosuppression in septic patients [35]. Based on this, a subgroup analysis was conducted in this study.…”

Section: Discussionmentioning

confidence: 99%

Association of current hepatitis B virus infection with mortality in adults with sepsis

Gao

et al. 2023

Epidemiol. Infect.

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This study aimed to determine the impact of current hepatitis B virus (HBV) infection on patients hospitalised with sepsis. This was a retrospective cohort study. Patients from three medical centres in Suzhou from 10 January 2016 to 23 July 2022 participated in this study. Demographic characteristics and clinical characteristics were collected. A total of 945 adult patients with sepsis were included. The median age was 66.0 years, 68.6% were male, 13.1% presented with current HBV infection, and 34.9% of all patients died. In the multivariable-adjusted Cox model, patients with current HBV infection had significantly higher mortality than those without (hazard ratio (HR) 1.50, 95% confidence interval (CI) 1.11–2.02). A subgroup analysis showed that being infected with HBV significantly increased in-hospital mortality in patients younger than 65 years old (HR 1.74, 95% CI 1.16–2.63), whereas no significant impact was observed in patients ≥65 years. The propensity score-matched case–control analysis showed that the rate of septic shock (91.4% vs. 62.1%, P < 0.001) and in-hospital mortality (48.3% vs. 35.3%, P = 0.045) were much higher in the propensity score-matched HBV infection group compared with the control group. In conclusion, current HBV infection was associated with mortality in adults with sepsis.

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“…Sepsis is a complex disease. Although its etiology has been most recently defined as “a dysregulated host response to infection” [ 1 ], different patients may have prior exposure to different pathological processes, such as trauma, burns, or acute abdomen [ 2 ]. Also, the pathogens that cause such infections may vary, such as bacteria, viruses, or fungi [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

“…Immunosuppression is an important cause of late death in early survivors of sepsis and remains difficult to treat [ 9 , 10 ]. Many studies have shown that lymphocyte failure contributes to immunosuppression in sepsis [ 2 , 4 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

Insights into the Roles of B Cells in Patients with Sepsis

Dong

Qin

et al. 2023

Journal of Immunology Research

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Sepsis is a life-threatening yet common disease, still posing high mortality worldwide. Sepsis-related deaths primarily occur during immunosuppression; the disease can hamper the numbers and function of B cells, which mediate innate and adaptive immune responses to maintain immune homeostasis. Dysfunction of B cells, along with aggravated immunosuppression, are closely related to poor prognosis. However, B cells in patients with sepsis have garnered little attention. This article focuses on the significance of B-cell subsets, including regulatory B cells, in sepsis and how the counts and function of circulating B cells are affected in patients with sepsis. Finally, potential B-cell-related immunotherapies for sepsis are explored.

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Expert consensus on the monitoring and treatment of sepsis-induced immunosuppression

Cited by 24 publications

References 129 publications

An integrative model with HLA‐DR, CD64, and PD‐1 for the diagnostic and prognostic evaluation of sepsis

An integrative model with HLA‐DR, CD64, and PD‐1 for the diagnostic and prognostic evaluation of sepsis

Association of current hepatitis B virus infection with mortality in adults with sepsis

Insights into the Roles of B Cells in Patients with Sepsis

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