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Development and validation of clinical criteria for critical illness-associated immune dysfunction: based on the
Yanyou Zhou1, Linfeng Tao1, Shengsheng Yang1
1Department of Emergency and Critical Care Medicine, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School of Nanjing Medical University, Suzhou Clinical Medical Center of Critical Care Medicine, Suzhou, China.
Insights
Critical illness-associated immune dysfunction (CIID) impacts ICU patients, often causing uncontrolled immune responses. New diagnostic criteria were developed and validated using the MIMIC-IV database, showing scientific validity and reliability for CIID patient identification.
Area of Science:
- Critical care medicine
- Immunology
- Health informatics
Background:
- Critical illness-associated immune dysfunction (CIID) is common in ICUs, leading to severe immune dysregulation.
- Existing diagnostic criteria for CIID are lacking, hindering clinical management.
- This study aimed to develop and validate initial diagnostic criteria for CIID.
Purpose of the Study:
- To propose and validate diagnostic criteria for critical illness-associated immune dysfunction (CIID).
- To investigate the association between different immune dysfunction patterns and patient mortality.
- To establish a reliable method for identifying CIID in intensive care unit (ICU) patients.
Main Methods:
- Literature review to establish initial diagnostic criteria for CIID.
- Analysis of the MIMIC-IV database, including 43,965 ICU patients.
- Categorization of patients into immune dysfunction (ID) and non-immune dysfunction (NID) groups, with ID subgroups: hyperinflammatory (HI), immunosuppression (IS), and HI+IS.
- Kaplan-Meier curves and COX regression analysis to assess mortality risks at 30 and 180 days.
Main Results:
- Approximately 77% of analyzed patients met the proposed CIID diagnostic criteria.
- Patients with CIID exhibited higher APACHE II scores compared to non-CIID patients.
- Short-term (30-day) mortality risk was highest in the HI subgroup and lowest in the IS subgroup.
- Long-term (180-day) mortality risk was highest in the IS subgroup and lowest in the HI subgroup.
Conclusions:
- The developed diagnostic criteria for CIID are scientifically valid and reliable, as confirmed by MIMIC-IV database analysis.
- Distinct immune dysfunction patterns (HI, IS, HI+IS) are associated with varying short-term and long-term mortality risks.
- The validated criteria will aid in the identification and management of CIID in critical care settings.
Background:
Critical illness-associated immune dysfunction (CIID) is prevalent in the ICU and frequently resulted in uncontrollably immune responses. Critical immunological dysfunction is understood to be important, although there are currently no clinically accepted diagnostic criteria for it. Given this, we examined the literature and developed an initial diagnostic criterion that we validated using the MIMIC-IV database.
Methods:
We searched the related literature in the last 32 years. Patients admitted to the ICU for the first time were selected by screening the MIMIC-IV database. Different criteria were used to categorize patients into groups related to immune dysfunction (ID) and non-immune dysfunction (NID). Within the ID group, patients were subdivided into three subgroups: hyperinflammatory (HI), immunosuppression (IS), and a subgroup combining immunosuppression and hyperinflammation (HI+IS). The APACHE II was used to measure the patients' severity. The association between immune dysfunction and mortality after 30 or 180 days was evaluated through the KM curves and COX regression analysis.
Results:
By summarizing relevant literature, we proposed the initial diagnostic criteria. The analysis included 43,965 patients, with approximately 77% meeting the diagnostic criteria for CIID. We observed that patients with immune dysfunction possessed higher APACHE II scores and there were differences in peak APACHE II among the three subgroups. When comparing patients' 30-day mortality in the COX model, it is evident that patients in the IS subgroup had the lowest risk and patients in the HI subgroup the greatest risk after accounting for all covariates. In contrast, patients in the IS subgroup had the highest risk of death, those in the HI subgroup had the lowest risk when comparing long-term mortality. In summary, we propose and validate diagnostic criteria related to CIID. Subgroup analyses were carried out, which also revealed variations between the three groups.
Conclusion:
The diagnostic criteria were confirmed by the MIMIC-IV database, demonstrating the diagnostic criteria were scientifically valid and reliable.
