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Profound acquired immunosuppression develops within a few days after septic shock in patients.
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Magnitude and/or persistence of sepsis-induced immunosuppression are associated with increased occurrence of nosocomial infections and mortality.
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In animal models, immunostimulation is associated with clinical improvement.
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Results from clinical trials based on interleukin 7 and granulocyte macrophage colony-stimulating factor immunoadjuvant therapies in septic shock patients are expected for 2018.
Management of Sepsis-Induced Immunosuppression
Section snippets
Key points
Introduction: the process of sepsis-induced immunosuppression
Although sepsis has been frequently described as solely inducing a tremendous systemic inflammation, current data indicate that it leads to a more complex immune response that evolves over time, with the simultaneous implication of both proinflammatory and anti-inflammatory mechanisms.1 As a result, after a short unbridled proinflammatory phase, an important subgroup of septic patients presents with profound acquired immunosuppression, which could be associated with difficulties to efficiently
Is There Still Room for Anti-inflammatory Strategies in Sepsis?
Although the main focus of this review is on immunostimulatory therapies in sepsis, there is likely still room for anti-inflammatory treatments in the very first hours of the syndrome. As discussed previously for immunostimulation, however, a major challenge is to identify patients who could benefit from such treatments (ie, in this case, patients who are still on ascending curve of the proinflammatory response). To date, despite a few promising reports,12 data are still missing regarding this
Novel Design for Randomized Controlled Trial in Sepsis
Because there is no clinical sign of immune dysfunctions, it is crucial to use appropriate biomarkers for patients’ stratification according to their immune status.11 Some patients spontaneously restore their immune functions overtime and, therefore, do not need to receive any immunoadjuvant intervention.9 Most importantly, before treating patients with immunostimulatory therapies, clinicians have to ascertain that the first unbridled inflammatory phase is over because immunostimulatory
Summary
The weight of sepsis-induced immunosuppression is now well established. Nevertheless, the demonstration of efficacy of immunostimulation in improving some or all deleterious outcomes remains to be made. That given, innovative immunomonitoring strategies characterizing the host immune response and thus permitting personalized immunostimulation seem a reasonable perspective. This would allow better taking into account the rapidly changing immune response overtime after initial infection, from
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2022, European Journal of Internal MedicineCitation Excerpt :Although knowledge of the mechanisms underlying sepsis-related immune-dysfunction have advanced in recent years, the lack of adequate markers to guide patient-specific intervention makes it unsurprising that clinical trials that have tested immune intervention strategies in septic patients have had so far been unsuccessful [4]. With regard to success in future studies, Venet et al. [5] propose that the key should be the stratification of patients, not only according to the characteristics of the infection and specific parameters of the patient, but also according to their immune status at a given time. The need for biomarker stratification of patients therefore seems a prerequisite in clinical trials to evaluate what the most appropriate immunomodulatory therapy should be in a given patient.
Hematological Support in Sepsis
2022, The Sepsis Codex
Disclosure Statement: The authors declare they do not have any conflicts of interest regarding this article.