Predicting Organ Dysfunction in Septic and Critically Ill Patients: A Prospective Cohort Study Using Rapid Ex Vivo Immune Profiling.
Crit Care Explor
; 6(7): e1106, 2024 Jul 01.
Article
en En
| MEDLINE
| ID: mdl-38916619
ABSTRACT
OBJECTIVES:
While cytokine response patterns are pivotal in mediating immune responses, they are also often dysregulated in sepsis and critical illness. We hypothesized that these immunological deficits, quantifiable through ex vivo whole blood stimulation assays, may be indicative of subsequent organ dysfunction.DESIGN:
In a prospective observational study, adult septic patients and critically ill but nonseptic controls were identified within 48 hours of critical illness onset. Using a rapid, ex vivo assay based on responses to lipopolysaccharide (LPS), anti-CD3/anti-CD28 antibodies, and phorbol 12-myristate 13-acetate with ionomycin, cytokine responses to immune stimulants were quantified. The primary outcome was the relationship between early cytokine production and subsequent organ dysfunction, as measured by the Sequential Organ Failure Assessment score on day 3 of illness (SOFAd3).SETTING:
Patients were recruited in an academic medical center and data processing and analysis were done in an academic laboratory setting. PATIENTS Ninety-six adult septic and critically ill nonseptic patients were enrolled.INTERVENTIONS:
None. MEASUREMENTS AND MAINRESULTS:
Elevated levels of tumor necrosis factor and interleukin-6 post-endotoxin challenge were inversely correlated with SOFAd3. Interferon-gamma production per lymphocyte was inversely related to organ dysfunction at day 3 and differed between septic and nonseptic patients. Clustering analysis revealed two distinct immune phenotypes, represented by differential responses to 18 hours of LPS stimulation and 4 hours of anti-CD3/anti-CD28 stimulation.CONCLUSIONS:
Our rapid immune profiling technique offers a promising tool for early prediction and management of organ dysfunction in critically ill patients. This information could be pivotal for early intervention and for preventing irreversible organ damage during the acute phase of critical illness.
Texto completo:
1
Banco de datos:
MEDLINE
Asunto principal:
Enfermedad Crítica
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Sepsis
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Insuficiencia Multiorgánica
Límite:
Adult
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Aged
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Revista:
Crit Care Explor
/
Crit. care explor
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Critical care explorations
Año:
2024
Tipo del documento:
Article