Early Prediction for Persistent Inflammation-Immunosuppression Catabolism Syndrome in Surgical Sepsis Patients

Abstract

Objective

To find the predictors for persistent inflammation-immunosuppression catabolism syndrome in ICU surgical septic patients.

Design

Single center observation study.

Participants

Inclusion: 1) patients ≥18, 2) admitted to the ICU after major surgery or transferred to the ICU within 48 hours after the diagnosis of sepsis following the definition of sepsis-3.0. Exclusion: 1) pregnant or lactating patients, 2) patients with severe immune deficiency, 3) patients that expired within 14 days after the diagnosis of sepsis.

Results

A total of 169 participants were included. After propensity score matching, PICS patients were found to have higher intensive care unit (ICU) mortality (32.4% vs 12.4%, p=0.046), 90-day mortality (32.4% vs 9.1%, p=0.006), and ICU-acquired infection rate (44.1% vs 12.7%, p<0.001), and longer ICU stays (29 vs 11 days, p<0.001) comparing to non-PICS patients. In multivariate logistic regression, it demonstrated that the SOFA score, Charlson co-morbidity index (CCI), albumin level on the ICU day 1, and lymphocyte count on the ICU day 3 were statistically significant. Sensitivity analysis was conducted with the receiver operating characteristic curve for a combination of the four parameters and the area under the curve was 0.838 (95% confidence interval 0.774–0.901).

Conclusion

The chronic disease condition and decreased immunity in the early course of sepsis were crucial for PICS. The combination of CCI, SOFA score, albumin level on ICU Day 1 and lymphocyte count on ICU Day 3 can be early predictor for PICS.

Keywords:

• sepsis
• persistent inflammation-immunosuppression catabolism syndrome

Data Sharing Statement

The datasets used and/or analyzed during the current study are available from the corresponding author Hong-ping Qu on reasonable request.

Ethics Approval and Consent to Participate

The study protocol was approved by the Ruijin Hospital Ethics Committee of Shanghai Jiaotong University School of Medicine, China.

Formal informed consent was obtained from the patients or their next of kin.

Consent for Publication

Consent for publication was obtained from the all the authors.

Acknowledgments

The study was conducted thanks to the helpful contributions of all the ICU staff and understanding and love of all the family members.

Disclosure

The authors declare that they have no competing interests.

Additional information

Funding

There is no funding to report.