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. 2020 Jan 10;9(1):191.
doi: 10.3390/jcm9010191.

Persistent Inflammation, Immunosuppression and Catabolism Syndrome (PICS) after Polytrauma: A Rare Syndrome with Major Consequences

Lillian Hesselink  1   2 , Ruben J Hoepelman  1 , Roy Spijkerman  1   2 , Mark C H de Groot  3 , Karlijn J P van Wessem  1 , Leo Koenderman  2   4 , Luke P H Leenen  1 , Falco Hietbrink  1
Affiliations

Persistent Inflammation, Immunosuppression and Catabolism Syndrome (PICS) after Polytrauma: A Rare Syndrome with Major Consequences

Lillian Hesselink et al. J Clin Med. .

Abstract

Nowadays, more trauma patients develop chronic critical illness (CCI), a state characterized by prolonged intensive care. Some of these CCI patients have disproportional difficulties to recover and suffer from recurrent infections, a syndrome described as the persistent inflammation, immunosuppression and catabolism syndrome (PICS). A total of 78 trauma patients with an ICU stay of ≥14 days (CCI patients) between 2007 and 2017 were retrospectively included. Within this group, PICS patients were identified through two ways: (1) their clinical course (≥3 infectious complications) and (2) by laboratory markers suggested in the literature (C-reactive protein (CRP) and lymphocytes), both in combination with evidence of increased catabolism. The incidence of PICS was 4.7 per 1000 multitrauma patients. The sensitivity and specificity of the laboratory markers was 44% and 73%, respectively. PICS patients had a longer hospital stay (median 83 vs. 40, p < 0.001) and required significantly more surgical interventions (median 13 vs. 3, p = 0.003) than other CCI patients. Thirteen PICS patients developed sepsis (72%) and 12 (67%) were readmitted at least once due to an infection. In conclusion, patients who develop PICS experience recurrent infectious complications that lead to prolonged hospitalization, many surgical procedures and frequent readmissions. Therefore, PICS forms a substantial burden on the patient and the hospital, despite its low incidence.

Keywords: PICS; immunology; infectious complications; trauma.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Overview of definitions used in this study and number of patients who fulfilled criteria according to these definitions. CCI = chronic critical illness, PICS = persistent inflammation, immunosuppression and catabolism syndrome, ICU = intensive care unit, BMI = Body Mass Index.
Figure 2
Figure 2
Flowchart of patient inclusion.
Figure 3
Figure 3
C-reactive protein levels and lymphocyte counts in clinically identified PICS patients (clinical PICS) in red and other CCI patients (no PICS) in green. Grey areas depict reference values. Data are presented as median with interquartile range.
See this image and copyright information in PMC

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