Research Progress of Sepsis Immunotherapy: A Bibliometric Analysis

Sepsis results in critical organ failure, considerable global mortality, and poses treatment obstacles. The primary issue with its pathophysiology is the improper functioning of the immune system in two phases: initially, there is excessive inflammation, followed by insufficient inflammation. This has generated interest in immunotherapy to restore the immune system to its normal state. This bibliometric analysis mapped the evolving research landscape of sepsis immunotherapy.

Articles and reviews related to sepsis immunotherapy, published between January 1, 2000, and December 31, 2025, in the Web of Science Core Collection, were retrieved, and bibliometric visualization analysis was performed using tools such as VOSviewer, CiteSpace, Scimago Graphica, Charticulator, and the R package bibliometrix.

A bibliometric analysis of 768 papers (2000-2025) indicates that the domain of sepsis immunotherapy research is seeing rapid expansion and dynamism. The annual publication rate is increasing exponentially, from an average of 11.3 per year (2000-2015) to 69.4 per year (2021-2025), reaching a peak of 79 in 2024. The United States tops the list with 246 articles and an H-index of 55, while China ranks second with 174 publications but exhibits a significantly lower citation impact. The analysis of collaborative networks reveals that the United States serves as a global hub with strong connections to China and European nations, while the European clusters maintain significant interconnections as well. The evolution of keywords delineates four distinct research phases: 2000-2005: focus on anti-inflammatory strategies targeting pivotal mediators such as tumor necrosis factor and cytokines; 2006-2012: shift toward acknowledging clinical complexity and immunosuppression while broadening research at the cellular level; 2013-2018: 2019-2025: in the context of the coronavirus disease 2019 pandemic, a phase of integration and response to emerging challenges marked by diverse clinically oriented advancements in immunomodulation, diagnosis, and integrated management. Journals like Frontiers in Immunology published the most number of articles (58), while the 2016 Sepsis-3 Consensus by Singer et al. was the most cited reference, underscoring its considerable influence. Joint citation analysis revealed that the Global Burden Study 2020 and the Sepsis-3 Consensus by Rudd et al. were the pivotal publications with the highest citation counts and prevalence intensity, respectively, highlighting their significance as foundational sources of information.

This bibliometric analysis shows how quickly research on immunotherapy for sepsis is moving forward. It has gone from focusing on anti-inflammatory strategies to precision treatment methods based on biomarkers. The US is still the best at research results and influence, but the lack of coordination in international cooperation has made research move more slowly. Recent research domains, including immune checkpoint inhibitors and multiomics integration, suggest a progression towards personalized algorithms. To accomplish the best clinical results, the future focus must go beyond borders, strengthen translational research, and use drugs based on biomarkers.