Abstract
BackgroundSepsis is a leading cause of mortality and critical illness worldwide and is associated with an increased mortality rate in the months following hospital discharge. The occurrence of persistent or new organ dysfunction(s) after septic shock raises questions about the mechanisms involved in the post-sepsis status. The present study aimed to explore the immune profiles of patients one year after being discharged from the intensive care unit (ICU) following treatment for abdominal septic shock.MethodsWe conducted a prospective, single-center, observational study in the surgical ICU of a university hospital. Eighty-six consecutive patients admitted for septic shock of abdominal origin were included in this study. Fifteen different plasma biomarkers were measured at ICU admission, at ICU discharge and at one year after ICU discharge. Three different clusters of biomarkers were distinguished according to their functions, namely: (1) inflammatory response, (2) cell damage and apoptosis, (3) immunosuppression and resolution of inflammation. The primary objective was to characterize variations in the immune status of septic shock patients admitted to ICU up to one year after ICU discharge. The secondary objective was to evaluate the relationship between these biomarker variations and patient outcomes.ResultsAt the onset of septic shock, we observed a cohesive pro-inflammatory profile and low levels of inflammation resolution markers. At ICU discharge, the immune status demonstrated decreased but persistent inflammation and increased immunosuppression, with elevated programmed cell death protein-1 (PD-1) levels, and a counterbalanced resolution process, with elevated levels of interleukin-10 (IL-10), resolvin D5 (RvD5), and IL-7. One year after hospital discharge, homeostasis was not completely restored with several markers of inflammation remaining elevated. Remarkably, IL-7 was persistently elevated, with levels comparable to those observed after ICU discharge, and PD-1, while lower, remained in the elevated abnormal range.ConclusionsIn this study, protracted immune disturbances were observed one year after ICU discharge. The study results suggested the presence of long-lasting immune illness disorders following a long-term septic insult, indicating the need for long-term patient follow up after ICU discharge and questioning the use of immune intervention to restore immune homeostasis after abdominal septic shock.
Highlights
Sepsis is a leading cause of mortality and critical illness worldwide and is associated with an increased mortality rate in the months following hospital discharge
Regarding the difference between the measurements taken at intensive care unit (ICU) discharge and at 1-year follow-up, we identified two types of biomarkers of change: those associated with a significant decrease (i.e., PD-1, resolvin D5 (RvD5), IL-6, caspase 3, IL-10, IL-17 and INF-γ) and those associated with no significant change from discharge to 1 year (i.e., Kyn, IDO, high mobility group Box 1 protein (HMGB1), uric acid, TNFα, Trp, IL-7, and RvD1) (Fig. 2)
This study aimed to explore the evolution of the immune profile of patients admitted to the ICU for septic shock of abdominal origin up to 1 year after ICU discharge
Summary
Sepsis is a leading cause of mortality and critical illness worldwide and is associated with an increased mortality rate in the months following hospital discharge. Patients are prone to decompensating or experiencing several diseases or organ dysfunction, such as cardiovascular disease [6,7,8], pulmonary disease [9], renal disease [10], depression and cognitive disabilities [11], and immune dysfunction [12]. These ailments lead to long-term decreased functional status [13]. The occurrence of persistent or new organ(s) dysfunction(s) after septic shock raises questions about the cellular, metabolic and immune mechanisms involved in the post-sepsis status
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