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Persistent Inflammation, Immunosuppression, and Catabolism: Evolution of Multiple Organ Dysfunction.

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Persistent inflammation, immunosuppression, and catabolism (PICS) is an evolving challenge in intensive care units (ICUs). This condition leads to prolonged recovery, re-hospitalization, and increased mortality, posing a significant future healthcare burden.

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Area of Science:

  • Critical Care Medicine
  • Immunology
  • Pathophysiology

Background:

  • Multiple organ dysfunction (MOD) has been a persistent problem in ICUs for over 40 years.
  • Evolving epidemiology of MOD due to improved survival from initial insults.
  • Previous MOD phenotypes were associated with high mortality and prolonged ICU stays.

Purpose of the Study:

  • To review the literature on the evolution of MOD phenotypes.
  • To identify the emergence and characteristics of persistent inflammation, immunosuppression, and catabolism (PICS).
  • To highlight PICS as a critical emerging challenge in surgical critical care.

Main Methods:

  • Comprehensive review of the English-language medical literature.
  • Analysis of historical trends and evolving understanding of MOD.
  • Identification of key features and outcomes associated with PICS.

Main Results:

  • MOD is recognized as a bimodal phenomenon, with improved survival from early sepsis.
  • A significant subset of survivors develop PICS, characterized by inflammation, immunosuppression, and catabolism.
  • PICS leads to loss of lean body mass, failure to rehabilitate, recurrent sepsis, and increased dependence.

Conclusions:

  • PICS is projected to become a major epidemic, particularly with an aging population and improved peri-operative care.
  • PICS represents the next frontier in surgical critical care.
  • A research program is established to investigate PICS pathogenesis and develop novel therapeutic strategies.