Sepsis et immunodépression acquise en réanimation

Abstract

AbstractSepsis is defined as the dysregulation of the host’s inflammatory response to an infection, leading to life-threatening organ failure. In 2017, sepsis was declared a major public health problem by the World Health Organization. It has recently been demonstrated that sepsis induces profound immunosuppression. Most importantly, this phase of immunosuppression is significantly associated with dormant virus reactivation, increased nosocomial infections, increased length of stay in intensive care and increased mortality. Understanding the mechanisms sustaining this immunosuppression has enabled the development of biomarkers (monocyte HLA-DR, % immature neutrophils, lymphocyte count, and PD-1 lymphocyte expression) that identify the patients most at risk. For the latter, a therapeutic alternative is currently being evaluated. This is based on individualized immunostimulation (IFN-γ, IL-7, anti-PD-1) which aims to accelerate the return of immune functions to normal ranges. Phase III trials are underway. This review provides an inventory of sepsis-induced immunosuppression and more generally introduces the notion of acquired immunodeficiency in intensive care.