Monocyte Function and Clinical Outcomes in Febrile and Afebrile Patients With Severe Sepsis

Drewry, Anne M.; Ablordeppey, Enyo; Murray, Ellen; Dalton, Catherine M.; Fuller, Brian M.; Kollef, Marin H.; Hotchkiss, Richard S.

doi:10.1097/shk.0000000000001083

Cited by 27 publications

(15 citation statements)

References 35 publications

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“…Flow cytometric analysis of samples was performed as previously described (39,55). Briefly, whole blood or PBMCs were stained for 30 minutes at room temperature, and red blood cells lysed (in the case of whole blood) using Red Blood Cell Lysis Buffer (BioLegend).…”

Section: Flow Cytometrymentioning

confidence: 99%

Severe immunosuppression and not a cytokine storm characterizes COVID-19 infections

Remy¹,

Mazer²,

Striker³

et al. 2020

JCI Insight

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272

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Section: Flow Cytometrymentioning

confidence: 99%

Severe immunosuppression and not a cytokine storm characterizes COVID-19 infections

Remy¹,

Mazer²,

Striker³

et al. 2020

JCI Insight

Self Cite

272

303

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“…Aside from accelerated apoptosis during sepsis, functional defects in monocytes also contribute to the pathophysiology of sepsis-induced immunosuppression, which is characterized by suppressed mononuclear cell HLA-DR expression in monocytes 79 . The decreased level of monocyte HLA-DR could be considered as a marker of monocyte anergy 80 , as it impairs the function of monocytes 81 and decreases lymphocyte proliferation in response to invading pathogens 82 .…”

Section: Apoptosis-induced Lymphopenia During Sepsismentioning

confidence: 99%

Pathological alteration and therapeutic implications of sepsis-induced immune cell apoptosis

2019

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Sepsis is a life-threatening organ dysfunction syndrome caused by dysregulated host response to infection that leads to uncontrolled inflammatory response followed by immunosuppression. However, despite the high mortality rate, no specific treatment modality or drugs with high efficacy is available for sepsis to date. Although improved treatment strategies have increased the survival rate during the initial state of excessive inflammatory response, recent trends in sepsis show that mortality occurs at a period of continuous immunosuppressive state in which patients succumb to secondary infections within a few weeks or months due to post-sepsis “immune paralysis.” Immune cell alteration induced by uncontrolled apoptosis has been considered a major cause of significant immunosuppression. Particularly, apoptosis of lymphocytes, including innate immune cells and adaptive immune cells, is associated with a higher risk of secondary infections and poor outcomes. Multiple postmortem studies have confirmed that sepsis-induced immune cell apoptosis occurs in all age groups, including neonates, pediatric, and adult patients, and it is considered to be a primary contributing factor to the immunosuppressive pathophysiology of sepsis. Therapeutic perspectives targeting apoptosis through various strategies could improve survival in sepsis. In this review article, we will focus on describing the major apoptosis process of immune cells with respect to physiologic and molecular mechanisms. Further, advances in apoptosis-targeted treatment modalities for sepsis will also be discussed.

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“…In EP, pancreatic infection is usually common, and fever is thought to be caused not only by SIRS but also by infection and even sepsis. Inability to present fever implies disrupted thermoregulatory response, impaired immunity, or underlying defective inflammatory response due to pathogen- or host-specific factors 35 . Higher mortality and morbidity were reported in afebrile bacteremia patients than in those with fever 35 , 36 .…”

Section: Discussionmentioning

confidence: 99%

Risk factors for mortality in emphysematous pancreatitis

Chou

Yang

et al. 2019

Journal of Drug Assessment

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Objective: To investigate the difference in the characteristics between patients with emphysematous pancreatitis (EP) who survived and those who died.Methods: PubMed search was performed to gather EP cases from March 1959 to February 2019. Forty-two articles with 58 EP cases were identified and met the study’s inclusion criteria. The elderly were defined as individuals aged >65 years. Data on patients’ demographics, clinical symptoms, laboratory results, treatments, outcomes, and mortality were collected and analyzed by chi-square test and Student’s t-test. p-Value <.05 (2-tailed) was set as the significance level.Results: Forty-seven men and eleven women aged 61.3 ± 15.9 (mean ± standard deviation) years were included. The elderly accounted for 43.1% (n = 25) of cases. There were 20 mortality cases, and 38 cases survived, with an overall mortality rate of 34.5%. Sex, underlying diseases, etiologies, and laboratory results were not significantly related to mortality. Older age was significantly related to mortality (p = .001). The shock was more commonly seen in the mortality group (100%) than in the survival group (21%) (p < .001). In contrast, fever was less frequent in the mortality group than in the survival group (25 vs. 71%, p = .002).Conclusions: EP patients have a high mortality rate (34.5%). Older age, afebrile status, and presence of shock are associated with high mortality. To improve the survival of this aggressive group, a further prospective investigation involving a larger sample size is necessary.

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Monocyte Function and Clinical Outcomes in Febrile and Afebrile Patients With Severe Sepsis

Abstract: Absence of fever is associated with suppressed HLA-DR expression over time, a finding suggestive of monocyte dysfunction in sepsis, as well as worse clinical outcomes.

Cited by 27 publications

References 35 publications

Severe immunosuppression and not a cytokine storm characterizes COVID-19 infections

Severe immunosuppression and not a cytokine storm characterizes COVID-19 infections

Pathological alteration and therapeutic implications of sepsis-induced immune cell apoptosis

Risk factors for mortality in emphysematous pancreatitis

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