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Updated: Jan 18, 2026
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A Data-Driven Approach to Quantifying Immune States in Sepsis
Published on: February 7, 2025
481
Immune Response Subphenotyping to Predict Mortality in Sepsis: A Prospective Study in Resource-Limited Setting.
Velma Herwanto1, Robert Sinto2, Leonard Nainggolan2
1Division of Internal Medicine, Faculty of Medicine Universitas Tarumanagara, Jakarta, Indonesia; Siloam Hospitals Kebon Jeruk, Jakarta, Indonesia.
Critical Care Explorations
|September 9, 2025
Summary
Sepsis patients with macrophage activation-like syndrome (MALS) have a significantly higher risk of in-hospital death. Identifying immune subphenotypes like MALS can improve sepsis mortality prediction, especially in resource-limited settings.
Area of Science:
- Immunology
- Critical Care Medicine
- Infectious Diseases
Background:
- Sepsis is a leading cause of death globally.
- Immune response heterogeneity complicates sepsis management and prognosis.
- Identifying immune subphenotypes can enhance outcome prediction.
Purpose of the Study:
- To determine if immune response classification predicts sepsis mortality.
- To evaluate the macrophage activation-like syndrome (MALS) and immunoparalysis subphenotypes as mortality predictors.
Main Methods:
- Prospective cohort study in a tertiary hospital.
- Adult sepsis patients within 24 hours of diagnosis were included.
- Classified patients into MALS, immunoparalysis, or unclassified based on serum ferritin and mHLA-DR levels.
Main Results:
- Of 200 patients, 54% had MALS, 9.5% had immunoparalysis, and the rest were unclassified.
- In-hospital mortality rates were 83.3% for MALS, 68.4% for immunoparalysis, and 51.1% for unclassified.
- MALS was an independent predictor of mortality (adjusted HR 1.7, p=0.01).
Conclusions:
- The MALS immune subphenotype independently predicts in-hospital mortality in sepsis.
- Immune subtyping offers a potential tool for sepsis prognostication.
- This classification may be particularly valuable in resource-limited settings.
