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Factors Associated With Early Recognition of Persistent Inflammation, Immunosuppression, and Catabolism Syndrome in

Bita Shahrami1, Elahe Karimpour-Razkenari, Amir Riazi

  • 1Author Affiliations: Department of Clinical Pharmacy, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran (Dr Shahrami, Dr Karimpour-Razkenari, Dr Riazi, Dr Najmeddin, and Dr Mojtahedzadeh); School of Clinical Sciences, Faculty of Health, Queensland University of Technology (QUT), Brisbane, Queensland, Australia (Dr Sefidani Forough); Department of Pharmacoeconomics & Pharmaceutical Administration, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran (Dr Davari); Faculty of Medicine, Semmelweis University, Budapest, Hungary (Mr Mojtahedzadeh); and Department of Anesthesiology & Critical Care, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran (Dr Najafi).

Critical Care Nursing Quarterly
|May 27, 2026
PubMed

Insights

Persistent inflammation, immunosuppression, and catabolism syndrome (PICS) complicates intensive care unit (ICU) stays. Early PICS detection may involve lactate levels, platelet and lymphocyte counts, and SOFA scores on day 14.

Area of Science:

  • Critical care medicine
  • Immunology
  • Intensive care research

Background:

  • Critical care advances reduce early mortality but increase Persistent Inflammation, Immunosuppression, and Catabolism Syndrome (PICS).
  • Factors for early PICS recognition remain unclear.
  • This study addresses the unclarified factors associated with PICS.

Purpose of the Study:

  • To investigate factors associated with the development of Persistent Inflammation, Immunosuppression, and Catabolism Syndrome (PICS) in intensive care unit (ICU) patients.
  • To identify potential early detection markers for PICS.

Main Methods:

  • Retrospective analysis of ICU patients within one year for Chronic Critical Illness (CCI) and PICS.
  • Categorization of patients into PICS (clinical-PICS, marker-positive PICS) and non-PICS groups.
  • Comparison of clinical characteristics and potential predictive factors between groups.

Main Results:

  • Clinical-PICS was linked to increased mortality, ICU duration, and sepsis incidence.
  • Day 14 markers included higher lactate, lower platelet and lymphocyte counts, and higher SOFA scores in PICS patients.
  • Acute kidney injury requiring renal replacement therapy was more common in PICS patients.

Conclusions:

  • Complicated ICU trajectories are common in PICS patients, highlighting the need for early detection.
  • Lactate, platelet, lymphocyte counts, SOFA scores, sepsis, transfusion, and RRT may predict PICS development.
  • Further research is required to refine PICS criteria and identify risk factors.
Abstract

Keywords:
chronic critical illnessimmunosuppression and catabolism syndromeintensive care unitmultiple organ failurepersistent inflammationrenal impairmentsepsis

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