A stratification strategy to predict secondary infection in critical illness-induced immune dysfunction: the REALIST score.
Critical care
HLA-DR
IL-10
Immunosuppression
Neutrophil
Secondary infection
Sepsis
Journal
Annals of intensive care
ISSN: 2110-5820
Titre abrégé: Ann Intensive Care
Pays: Germany
ID NLM: 101562873
Informations de publication
Date de publication:
17 Aug 2022
17 Aug 2022
Historique:
received:
27
01
2022
accepted:
03
08
2022
entrez:
17
8
2022
pubmed:
18
8
2022
medline:
18
8
2022
Statut:
epublish
Résumé
Although multiple individual immune parameters have been demonstrated to predict the occurrence of secondary infection after critical illness, significant questions remain with regards to the selection, timing and clinical utility of such immune monitoring tests. As a sub-study of the REALISM study, the REALIST score was developed as a pragmatic approach to help clinicians better identify and stratify patients at high risk for secondary infection, using a simple set of relatively available and technically robust biomarkers. This is a sub-study of a single-centre prospective cohort study of immune profiling in critically ill adults admitted after severe trauma, major surgery or sepsis/septic shock. For the REALIST score, five immune parameters were pre-emptively selected based on their clinical applicability and technical robustness. Predictive power of different parameters and combinations of parameters was assessed. The main outcome of interest was the occurrence of secondary infection within 30 days. After excluding statistically redundant and poorly predictive parameters, three parameters remained in the REALIST score: mHLA-DR, percentage of immature (CD10 We derived and presented the REALIST score, a simple and pragmatic stratification strategy which provides clinicians with a clear assessment of the immune status of their patients. This new tool could help optimize care of these individuals and could contribute in designing future trials of immune stimulation strategies.
Sections du résumé
BACKGROUND
BACKGROUND
Although multiple individual immune parameters have been demonstrated to predict the occurrence of secondary infection after critical illness, significant questions remain with regards to the selection, timing and clinical utility of such immune monitoring tests.
RESEARCH QUESTION
OBJECTIVE
As a sub-study of the REALISM study, the REALIST score was developed as a pragmatic approach to help clinicians better identify and stratify patients at high risk for secondary infection, using a simple set of relatively available and technically robust biomarkers.
STUDY DESIGN AND METHODS
METHODS
This is a sub-study of a single-centre prospective cohort study of immune profiling in critically ill adults admitted after severe trauma, major surgery or sepsis/septic shock. For the REALIST score, five immune parameters were pre-emptively selected based on their clinical applicability and technical robustness. Predictive power of different parameters and combinations of parameters was assessed. The main outcome of interest was the occurrence of secondary infection within 30 days.
RESULTS
RESULTS
After excluding statistically redundant and poorly predictive parameters, three parameters remained in the REALIST score: mHLA-DR, percentage of immature (CD10
INTERPRETATION
CONCLUSIONS
We derived and presented the REALIST score, a simple and pragmatic stratification strategy which provides clinicians with a clear assessment of the immune status of their patients. This new tool could help optimize care of these individuals and could contribute in designing future trials of immune stimulation strategies.
Identifiants
pubmed: 35976460
doi: 10.1186/s13613-022-01051-3
pii: 10.1186/s13613-022-01051-3
pmc: PMC9382015
doi:
Types de publication
Journal Article
Langues
eng
Pagination
76Subventions
Organisme : Fondation Générale de Santé
ID : ANR-10-AIRT-03
Investigateurs
Sophie Arnal
(S)
Caroline Augris-Mathieu
(C)
Frédérique Bayle
(F)
Liana Caruso
(L)
Charles-Eric Ber
(CE)
Asma Ben-Amor
(A)
Anne-Sophie Bellocq
(AS)
Farida Benatir
(F)
Anne Bertin-Maghit
(A)
Marc Bertin-Maghit
(M)
André Boibieux
(A)
Yves Bouffard
(Y)
Jean-Christophe Cejka
(JC)
Valérie Cerro
(V)
Jullien Crozon-Clauzel
(J)
Julien Davidson
(J)
Sophie Debord-Peguet
(S)
Benjamin Delwarde
(B)
Robert Deleat-Besson
(R)
Claire Delsuc
(C)
Bertrand Devigne
(B)
Laure Fayolle-Pivot
(L)
Alexandre Faure
(A)
Bernard Floccard
(B)
Julie Gatel
(J)
Charline Genin
(C)
Thibaut Girardot
(T)
Arnaud Gregoire
(A)
Baptiste Hengy
(B)
Laetitia Huriaux
(L)
Catherine Jadaud
(C)
Alain Lepape
(A)
Véronique Leray
(V)
Anne-Claire Lukaszewicz
(AC)
Guillaume Marcotte
(G)
Olivier Martin
(O)
Marie Matray
(M)
Delphine Maucort-Boulch
(D)
Pascal Meuret
(P)
Céline Monard
(C)
Florent Moriceau
(F)
Guillaume Monneret
(G)
Nathalie Panel
(N)
Najia Rahali
(N)
Thomas Rimmele
(T)
Cyrille Truc
(C)
Thomas Uberti
(T)
Hélène Vallin
(H)
Fabienne Venet
(F)
Sylvie Tissot
(S)
Abbès Zadam
(A)
Sophie Blein
(S)
Karen Brengel-Pesce
(K)
Elisabeth Cerrato
(E)
Valerie Cheynet
(V)
Emmanuelle Gallet-Gorius
(E)
Audrey Guichard
(A)
Camille Jourdan
(C)
Natacha Koenig
(N)
François Mallet
(F)
Boris Meunier
(B)
Virginie Moucadel
(V)
Marine Mommert
(M)
Guy Oriol
(G)
Alexandre Pachot
(A)
Estelle Peronnet
(E)
Claire Schrevel
(C)
Olivier Tabone
(O)
Julien Textoris
(J)
Javier Yugueros Marcos
(JY)
Jeremie Becker
(J)
Frederic Bequet
(F)
Yacine Bounab
(Y)
Florian Brajon
(F)
Bertrand Canard
(B)
Muriel Collus
(M)
Nathalie Garcon
(N)
Irene Gorse
(I)
Cyril Guyard
(C)
Fabien Lavocat
(F)
Philippe Leissner
(P)
Karen Louis
(K)
Maxime Mistretta
(M)
Jeanne Moriniere
(J)
Yoann Mouscaz
(Y)
Laura Noailles
(L)
Magali Perret
(M)
Frederic Reynier
(F)
Cindy Riffaud
(C)
Mary-Luz Rol
(ML)
Nicolas Sapay
(N)
Trang Tran
(T)
Christophe Vedrine
(C)
Christophe Carre
(C)
Pierre Cortez
(P)
Aymeric Monfort
(A)
Karine Florin
(K)
Laurent Fraisse
(L)
Isabelle Fugier
(I)
Sandrine Payrard
(S)
Annick Peleraux
(A)
Laurence Quemeneur
(L)
Andrew Griffiths
(A)
Stephanie Toetsch
(S)
Teri Ashton
(T)
Peter J Gough
(PJ)
Scott B Berger
(SB)
David Gardiner
(D)
Iain Gillespie
(I)
Aidan Macnamara
(A)
Aparna Raychaudhuri
(A)
Rob Smylie
(R)
Lionel Tan
(L)
Craig Tipple
(C)
Informations de copyright
© 2022. The Author(s).
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