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Review
. 2021 Apr 17;10(8):1742.
doi: 10.3390/jcm10081742.

Dysregulated Immunity and Immunotherapy after Sepsis

Dijoia B Darden  1 , Lauren S Kelly  1 , Brittany P Fenner  1 , Lyle L Moldawer  1 , Alicia M Mohr  1 , Philip A Efron  1
Affiliations
Review

Dysregulated Immunity and Immunotherapy after Sepsis

Dijoia B Darden et al. J Clin Med. .

Abstract

Implementation of protocolized surveillance, diagnosis, and management of septic patients, and of surgical sepsis patients in particular, is shown to result in significantly increased numbers of patients surviving their initial hospitalization. Currently, most surgical sepsis patients will rapidly recover from sepsis; however, many patients will not rapidly recover, but instead will go on to develop chronic critical illness (CCI) and experience dismal long-term outcomes. The elderly and comorbid patient is highly susceptible to death or CCI after sepsis. Here, we review aspects of the Persistent Inflammation, Immunosuppression, and Catabolism Syndrome (PICS) endotype to explain the underlying pathobiology of a dysregulated immune system in sepsis survivors who develop CCI; then, we explore targets for immunomodulatory therapy.

Keywords: CCI; MDSC; PICS; immunosuppression; inflammation; sepsis.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Proposed hypothesis for Persistent Inflammation, Immunosuppression, and Catabolism Syndrome (PICS) in sepsis survivors. Abbreviations: MDSC—myeloid-derived suppressor cell; DAMP—damage-associated molecular protein; LTAC—long-term acute care facility.
Figure 2
Figure 2
Pathophysiology of Chronic Critical Illness (CCI) and Persistent Inflammation, Immunosuppression, and Catabolism Syndrome (PICS). Abbreviations: DAMP—damage-associated molecular protein, EMV—exosome and microvesicle.
See this image and copyright information in PMC

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