Expert consensus on the monitoring and treatment of sepsis-induced immunosuppression

doi:10.1186/s40779-022-00430-y

. 2022 Dec 26;9(1):74.

doi: 10.1186/s40779-022-00430-y.

Expert consensus on the monitoring and treatment of sepsis-induced immunosuppression

Fei Pei^#¹, Ren-Qi Yao^#^{2

3}, Chao Ren^#², Soheyl Bahrami⁴, Timothy R Billiar⁵, Irshad H Chaudry⁶, De-Chang Chen⁷, Xu-Lin Chen⁸, Na Cui⁹, Xiang-Ming Fang¹⁰, Yan Kang¹¹, Wei-Qin Li¹², Wen-Xiong Li¹³, Hua-Ping Liang¹⁴, Hong-Yuan Lin¹⁵, Ke-Xuan Liu¹⁶, Ben Lu¹⁷, Zhong-Qiu Lu¹⁸, Marc Maegele¹⁹, Tian-Qing Peng²⁰, You Shang²¹, Lei Su²², Bing-Wei Sun²³, Chang-Song Wang²⁴, Jian Wang²⁵, Jiang-Huai Wang²⁶, Ping Wang²⁷, Jian-Feng Xie²⁸, Li-Xin Xie²⁹, Li-Na Zhang³⁰, Basilia Zingarelli³¹, Xiang-Dong Guan³², Jian-Feng Wu^{33

34}, Yong-Ming Yao³⁵; Shock and Sepsis Society of Chinese Research Hospital Association; China Critical Care Immunotherapy Research Group; International Federation of the Shock Societies (IFSS)

Affiliations

¹ Department of Critical Care Medicine, the First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan Er Road, Yuexiu District, Guangzhou, 510080, Guangdong, China.
² Translational Medicine Research Center, Medical Innovation Research Division and Fourth Medical Center of the Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853, China.
³ Department of Burn Surgery, the First Affiliated Hospital of Naval Medical University, Shanghai, 200433, China.
⁴ Ludwig-Boltzmann Institute for Experimental and Clinical Traumatology, 1200, Vienna, Austria.
⁵ Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, 15213, USA.
⁶ Center for Surgical Research and Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, 35294, USA.
⁷ Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiaotong University, Shanghai, 200025, China.
⁸ Department of Burns, the First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China.
⁹ Department of Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China.
¹⁰ Department of Anesthesiology, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 31003, China.
¹¹ Department of Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, 610041, China.
¹² Department of Critical Care Medicine, General Hospital of Eastern Theater Command of Chinese PLA, Nanjing, 210002, China.
¹³ Department of Surgical Intensive Critical Unit, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100020, China.
¹⁴ State Key Laboratory of Trauma, Burns and Combined Injury, Research Institute of Surgery, Daping Hospital, Army Medical University, Chongqing, 400042, China.
¹⁵ Department of Critical Care Medicine, Fourth Medical Center of the Chinese PLA General Hospital, Beijing, 100048, China.
¹⁶ Department of Anesthesiology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China.
¹⁷ Department of Critical Care Medicine and Hematology, the Third Xiangya Hospital, Central South University, Changsha, 410000, China.
¹⁸ Emergency Department, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China.
¹⁹ Department of Traumatology and Orthopedic Surgery, University Witten-Herdecke, 51109, Cologne, Germany.
²⁰ Critical Illness Research, Lawson Health Research Institute, London Health Sciences Centre, London, ON, N6A 4G4, Canada.
²¹ Department of Critical Care Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
²² Department of Intensive Care Unit, General Hospital of Southern Theater Command of Chinese PLA, Guangzhou, 510030, China.
²³ Department of Burns and Plastic Surgery, Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, 215002, China.
²⁴ Department of Critical Care Medicine, Harbin Medical University Cancer Hospital, Harbin, 150081, China.
²⁵ Children's Hospital of Soochow University, Pediatric Research Institute of Soochow University, Suzhou, 215123, China.
²⁶ Department of Academic Surgery, University College Cork, Cork University Hospital, Cork, T12 E8YV, Ireland.
²⁷ Center for Immunology and Inflammation, the Feinstein Institute for Medical Research, Northwell Health, Manhasset, NY, 11030, USA.
²⁸ Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, China.
²⁹ Department of Pulmonary and Critical Care Medicine, Chinese PLA General Hospital, Beijing, 100853, China.
³⁰ Department of Critical Care Medicine, Xiangya Hospital, Central South University, Changsha, 410008, China.
³¹ Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 41073, USA.
³² Department of Critical Care Medicine, the First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan Er Road, Yuexiu District, Guangzhou, 510080, Guangdong, China. guanxd@mail.sysu.edu.cn.
³³ Department of Critical Care Medicine, the First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan Er Road, Yuexiu District, Guangzhou, 510080, Guangdong, China. wujianf@mail.sysu.edu.cn.
³⁴ Guangdong Clinical Research Center for Critical Care Medicine, Guangzhou, 510080, China. wujianf@mail.sysu.edu.cn.
³⁵ Translational Medicine Research Center, Medical Innovation Research Division and Fourth Medical Center of the Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853, China. c_ff@sina.com.

^# Contributed equally.

PMID: 36567402
PMCID: PMC9790819
DOI: 10.1186/s40779-022-00430-y

Expert consensus on the monitoring and treatment of sepsis-induced immunosuppression

Fei Pei et al. Mil Med Res. 2022.

. 2022 Dec 26;9(1):74.

doi: 10.1186/s40779-022-00430-y.

Authors

Affiliations

¹ Department of Critical Care Medicine, the First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan Er Road, Yuexiu District, Guangzhou, 510080, Guangdong, China.
² Translational Medicine Research Center, Medical Innovation Research Division and Fourth Medical Center of the Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853, China.
³ Department of Burn Surgery, the First Affiliated Hospital of Naval Medical University, Shanghai, 200433, China.
⁴ Ludwig-Boltzmann Institute for Experimental and Clinical Traumatology, 1200, Vienna, Austria.
⁵ Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, 15213, USA.
⁶ Center for Surgical Research and Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, 35294, USA.
⁷ Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiaotong University, Shanghai, 200025, China.
⁸ Department of Burns, the First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China.
⁹ Department of Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China.
¹⁰ Department of Anesthesiology, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 31003, China.
¹¹ Department of Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, 610041, China.
¹² Department of Critical Care Medicine, General Hospital of Eastern Theater Command of Chinese PLA, Nanjing, 210002, China.
¹³ Department of Surgical Intensive Critical Unit, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100020, China.
¹⁴ State Key Laboratory of Trauma, Burns and Combined Injury, Research Institute of Surgery, Daping Hospital, Army Medical University, Chongqing, 400042, China.
¹⁵ Department of Critical Care Medicine, Fourth Medical Center of the Chinese PLA General Hospital, Beijing, 100048, China.
¹⁶ Department of Anesthesiology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China.
¹⁷ Department of Critical Care Medicine and Hematology, the Third Xiangya Hospital, Central South University, Changsha, 410000, China.
¹⁸ Emergency Department, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China.
¹⁹ Department of Traumatology and Orthopedic Surgery, University Witten-Herdecke, 51109, Cologne, Germany.
²⁰ Critical Illness Research, Lawson Health Research Institute, London Health Sciences Centre, London, ON, N6A 4G4, Canada.
²¹ Department of Critical Care Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
²² Department of Intensive Care Unit, General Hospital of Southern Theater Command of Chinese PLA, Guangzhou, 510030, China.
²³ Department of Burns and Plastic Surgery, Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, 215002, China.
²⁴ Department of Critical Care Medicine, Harbin Medical University Cancer Hospital, Harbin, 150081, China.
²⁵ Children's Hospital of Soochow University, Pediatric Research Institute of Soochow University, Suzhou, 215123, China.
²⁶ Department of Academic Surgery, University College Cork, Cork University Hospital, Cork, T12 E8YV, Ireland.
²⁷ Center for Immunology and Inflammation, the Feinstein Institute for Medical Research, Northwell Health, Manhasset, NY, 11030, USA.
²⁸ Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, China.
²⁹ Department of Pulmonary and Critical Care Medicine, Chinese PLA General Hospital, Beijing, 100853, China.
³⁰ Department of Critical Care Medicine, Xiangya Hospital, Central South University, Changsha, 410008, China.
³¹ Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 41073, USA.
³² Department of Critical Care Medicine, the First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan Er Road, Yuexiu District, Guangzhou, 510080, Guangdong, China. guanxd@mail.sysu.edu.cn.
³³ Department of Critical Care Medicine, the First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan Er Road, Yuexiu District, Guangzhou, 510080, Guangdong, China. wujianf@mail.sysu.edu.cn.
³⁴ Guangdong Clinical Research Center for Critical Care Medicine, Guangzhou, 510080, China. wujianf@mail.sysu.edu.cn.
³⁵ Translational Medicine Research Center, Medical Innovation Research Division and Fourth Medical Center of the Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853, China. c_ff@sina.com.

^# Contributed equally.

PMID: 36567402
PMCID: PMC9790819
DOI: 10.1186/s40779-022-00430-y

Abstract

Emerged evidence has indicated that immunosuppression is involved in the occurrence and development of sepsis. To provide clinical practice recommendations on the immune function in sepsis, an expert consensus focusing on the monitoring and treatment of sepsis-induced immunosuppression was developed. Literature related to the immune monitoring and treatment of sepsis were retrieved from PubMed, Web of Science, and Chinese National Knowledge Infrastructure to design items and expert opinions were collected through an online questionnaire. Then, the Delphi method was used to form consensus opinions, and RAND appropriateness method was developed to provide consistency evaluation and recommendation levels for consensus opinions. This consensus achieved satisfactory results through two rounds of questionnaire survey, with 2 statements rated as perfect consistency, 13 as very good consistency, and 9 as good consistency. After summarizing the results, a total of 14 strong recommended opinions, 8 weak recommended opinions and 2 non-recommended opinions were produced. Finally, a face-to-face discussion of the consensus opinions was performed through an online meeting, and all judges unanimously agreed on the content of this consensus. In summary, this expert consensus provides a preliminary guidance for the monitoring and treatment of immunosuppression in patients with sepsis.

Keywords: Immune function monitoring; Immunomodulatory therapy; Immunosuppression; Sepsis.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

**Fig. 2**
Summary of the recommendations on the monitoring and treatment of sepsis-induced immunosuppression. mHLA-DR monocyte human leukocyte antigen DR, GM-CSF granulocyte–macrophage colony-stimulating factor, Treg regulatory T cell

See this image and copyright information in PMC

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References

1. Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The third international consensus definitions for sepsis and septic shock (sepsis-3) JAMA. 2016;315(8):801–810. doi: 10.1001/jama.2016.0287. - DOI - PMC - PubMed
1. Rudd KE, Johnson SC, Agesa KM, Shackelford KA, Tsoi D, Kievlan DR, et al. Global, regional, and national sepsis incidence and mortality, 1990–2017: analysis for the Global Burden of Disease Study. Lancet. 2020;395(10219):200–211. doi: 10.1016/S0140-6736(19)32989-7. - DOI - PMC - PubMed
1. van der Poll T, van de Veerdonk FL, Scicluna BP, Netea MG. The immunopathology of sepsis and potential therapeutic targets. Nat Rev Immunol. 2017;17(7):407–420. doi: 10.1038/nri.2017.36. - DOI - PubMed
1. Venet F, Monneret G. Advances in the understanding and treatment of sepsis-induced immunosuppression. Nat Rev Nephrol. 2018;14(2):121–137. doi: 10.1038/nrneph.2017.165. - DOI - PubMed
1. van der Poll T, Shankar-Hari M, Wiersinga WJ. The immunology of sepsis. Immunity. 2021;54(11):2450–2464. doi: 10.1016/j.immuni.2021.10.012. - DOI - PubMed

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[1] Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The third international consensus definitions for sepsis and septic shock (sepsis-3) JAMA. 2016;315(8):801–810. doi: 10.1001/jama.2016.0287. - DOI - PMC - PubMed

[2] Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The third international consensus definitions for sepsis and septic shock (sepsis-3) JAMA. 2016;315(8):801–810. doi: 10.1001/jama.2016.0287. - DOI - PMC - PubMed

[3] Rudd KE, Johnson SC, Agesa KM, Shackelford KA, Tsoi D, Kievlan DR, et al. Global, regional, and national sepsis incidence and mortality, 1990–2017: analysis for the Global Burden of Disease Study. Lancet. 2020;395(10219):200–211. doi: 10.1016/S0140-6736(19)32989-7. - DOI - PMC - PubMed

[4] Rudd KE, Johnson SC, Agesa KM, Shackelford KA, Tsoi D, Kievlan DR, et al. Global, regional, and national sepsis incidence and mortality, 1990–2017: analysis for the Global Burden of Disease Study. Lancet. 2020;395(10219):200–211. doi: 10.1016/S0140-6736(19)32989-7. - DOI - PMC - PubMed

[5] van der Poll T, van de Veerdonk FL, Scicluna BP, Netea MG. The immunopathology of sepsis and potential therapeutic targets. Nat Rev Immunol. 2017;17(7):407–420. doi: 10.1038/nri.2017.36. - DOI - PubMed

[6] van der Poll T, van de Veerdonk FL, Scicluna BP, Netea MG. The immunopathology of sepsis and potential therapeutic targets. Nat Rev Immunol. 2017;17(7):407–420. doi: 10.1038/nri.2017.36. - DOI - PubMed

[7] Venet F, Monneret G. Advances in the understanding and treatment of sepsis-induced immunosuppression. Nat Rev Nephrol. 2018;14(2):121–137. doi: 10.1038/nrneph.2017.165. - DOI - PubMed

[8] Venet F, Monneret G. Advances in the understanding and treatment of sepsis-induced immunosuppression. Nat Rev Nephrol. 2018;14(2):121–137. doi: 10.1038/nrneph.2017.165. - DOI - PubMed

[9] van der Poll T, Shankar-Hari M, Wiersinga WJ. The immunology of sepsis. Immunity. 2021;54(11):2450–2464. doi: 10.1016/j.immuni.2021.10.012. - DOI - PubMed

[10] van der Poll T, Shankar-Hari M, Wiersinga WJ. The immunology of sepsis. Immunity. 2021;54(11):2450–2464. doi: 10.1016/j.immuni.2021.10.012. - DOI - PubMed

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Expert consensus on the monitoring and treatment of sepsis-induced immunosuppression

Affiliations

Expert consensus on the monitoring and treatment of sepsis-induced immunosuppression

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