Dysregulated Immunity and Immunotherapy after Sepsis.

Area of Science:

• Critical care medicine
• Immunology
• Surgical infections

Background:

• Protocolized care significantly increases survival rates for septic patients, especially surgical sepsis.
• A subset of surgical sepsis patients do not recover rapidly, progressing to chronic critical illness (CCI) with poor long-term outcomes.
• Elderly and comorbid patients are at higher risk for mortality or CCI following sepsis.

Purpose of the Study:

• To review the Persistent Inflammation, Immunosuppression, and Catabolism Syndrome (PICS) endotype in sepsis survivors.
• To elucidate the pathobiology of immune dysregulation in sepsis survivors who develop CCI.
• To identify potential targets for immunomodulatory therapies.

Main Methods:

• Literature review focusing on PICS and immune dysregulation in sepsis.
• Analysis of pathobiology underlying chronic critical illness post-sepsis.
• Exploration of immunomodulatory treatment strategies.

Main Results:

• Protocolized care enhances initial survival from sepsis.
• Persistent Inflammation, Immunosuppression, and Catabolism Syndrome (PICS) characterizes a significant subgroup of sepsis survivors.
• Immune system dysregulation is central to the development of CCI in sepsis survivors.

Conclusions:

• While initial sepsis survival is improving, managing long-term outcomes and CCI remains a challenge.
• Understanding the PICS endotype offers insights into the mechanisms of immune dysregulation.
• Targeting immune pathways presents a promising avenue for improving long-term outcomes in sepsis survivors.