Monitoring immune dysfunctions in the septic patient: a new skin for the old ceremony

Abstract

Septic syndromes represent a major although largely underrecognized healthcare problem worldwide, accounting for thousands of deaths every year. It is now agreed that sepsis deeply perturbs immune homeostasis by inducing an initial tremendous systemic inflammatory response which is accompanied by an antiinflammatory process, acting as negative feedback. This compensatory inhibitory response secondly becomes deleterious as nearly all immune functions are compromised. These alterations might be directly responsible for worsening outcome, as they may play a major role in the decreased resistance to nosocomial infections in patients who survived initial resuscitation. Consequently, immunostimulatory therapies may now be assessed for the treatment of sepsis. This review focuses on immune dysfunctions described in septic patients and on their potential use as markers on a routine standardized basis for prediction of adverse outcome or of occurrence of secondary nosocomial infections. This constitutes a prerequisite to a staging system for individualized treatment for these hitherto deadly syndromes.

Figure 1

Simplified description of pro- and antiinflammatory systemic immune responses over time after septic shock. The dashed lines represent pro- or antiinflammatory responses; the bold line represents the result at the systemic level. The shift from a proinflammatory to an antiinflammatory immune response predominant at the systemic level likely occurs before 24 h after diagnosis of shock.