Sepsis severe or septic shock: outcome according to the immune status and immunodeficiency profile.

28. 07. 2014

Tolsma V, Schwebel C, Azoulay E, Darmon M, Souweine B, Vesin A, Goldgran-Toledano D, Lugosi M, Jamali S, Cheval C, Adrie C, Kallel H, Descorps-Declere A, Garrouste-Orgeas M, Bouadma L, Timsit JF.
Chest. 2014 Jul 17. doi: 10.1378/chest.13-2618.

ABSTRACT

Objective:
to evaluate the influence of the immune profile on the outcome at day 28 (D28) of patients admitted in ICU for septic shock or severe sepsis.

Materials and Methods:
we conducted an observational study using a prospective multicenter database, and included all patients admitted in 11 ICUs for severe sepsis or septic shock, from January 1997 to August 2011. Seven profiles of immunodeficiency were defined. The prognostic analysis used a competitive risk model (Fine and Gray), in which being alive at ICU or hospital discharge before D28 competed with death.

Results:
among the 1981 included patients, 607 (31%) were immunocompromised (including non-neutropenic solid tumor (19.6%), non-neutropenic hematological malignancies (26.3%), all-cause neutropenia (28%)). Compared to immunocompetent patients, immunocompromised patients were younger, with less comorbidity, were more often admitted for medical reasons, and presented less often septic shock. The D28 crude mortality was 31.3% in immunocompromised patients and 28.8%, in immunocompetent patients (p=0.26). However, after adjustment for other prognostic factors, immunodeficiency was an independent risk factor for death at D28 (sHR 1.37 [1.12-1.67]). The immunodeficiency profiles independently associated with death were AIDS (sHR = 1.9), non-neutropenic solid tumor (sHR = 1.8), non-neutropenic hematological malignancies (sHR = 1.4), and all-cause neutropenia (sHR = 1.7).

Conclusion:
immunodeficiency is common in patients with severe sepsis or septic shock. Despite a similar crude mortality, immunodeficiency was associated with an increased risk of short-term mortality after multivariate analysis. Neutropenia and specific, but not all, profiles of immunodeficiency were independently associated with an increased risk of death.

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