Advocating for the recognition of underlying immunosuppression in critical illness
Summary: Immunosuppression, characterised by impaired immune function, significantly influences infection risk and ICU admissions in critically ill patients. This manuscript highlights the need for grading criteria to assess pre-existing immunosuppression, considering factors like underlying disease...
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| Format: | Article |
| Language: | English |
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Elsevier
2025-07-01
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| Series: | EClinicalMedicine |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2589537025002329 |
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| author | Ignacio Martin-Loeches Sascha David Frédéric Pène Louis Kreitmann Lene Russel Kathryn Puxty João Santos Silva Ana Vagos Mata Ben Creagh-Brown Pedro Castro Jorge Salluh Loreto Vidaur-Tello Saad Nseir Elie Azoulay |
| author_facet | Ignacio Martin-Loeches Sascha David Frédéric Pène Louis Kreitmann Lene Russel Kathryn Puxty João Santos Silva Ana Vagos Mata Ben Creagh-Brown Pedro Castro Jorge Salluh Loreto Vidaur-Tello Saad Nseir Elie Azoulay |
| author_sort | Ignacio Martin-Loeches |
| collection | DOAJ |
| description | Summary: Immunosuppression, characterised by impaired immune function, significantly influences infection risk and ICU admissions in critically ill patients. This manuscript highlights the need for grading criteria to assess pre-existing immunosuppression, considering factors like underlying diseases, immunosuppressive therapies, and clinical outcomes variability. We propose a grading system categorising immunosuppression as mild, moderate, or severe. These criteria, while preliminary, offer a foundation for future refinement. Patients with moderate immunosuppression may require closer infection surveillance, while those with severe immunosuppression might need early immune reconstitution therapies. Prospective studies integrating biomarkers and advanced tools like machine learning are essential to validate and enhance the grading system for clinical use. This approach aims to make immunosuppression assessments more predictive and actionable. This narrative review synthesises current knowledge and provides guidance for individualised management. Effective care requires balancing immunosuppressive treatments with infection prevention, including risk assessments, optimisation, and medication reconciliation. Ultimately, the manuscript advocates for developing robust grading criteria to improve clinical decision-making and outcomes for critically ill immunocompromised patients. Funding: Not receiving any funding. |
| format | Article |
| id | doaj-art-8a770bfc801849b19390b925b32b8537 |
| institution | Kabale University |
| issn | 2589-5370 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | Elsevier |
| record_format | Article |
| series | EClinicalMedicine |
| spelling | doaj-art-8a770bfc801849b19390b925b32b85372025-08-20T03:28:29ZengElsevierEClinicalMedicine2589-53702025-07-018510330010.1016/j.eclinm.2025.103300Advocating for the recognition of underlying immunosuppression in critical illnessIgnacio Martin-Loeches0Sascha David1Frédéric Pène2Louis Kreitmann3Lene Russel4Kathryn Puxty5João Santos Silva6Ana Vagos Mata7Ben Creagh-Brown8Pedro Castro9Jorge Salluh10Loreto Vidaur-Tello11Saad Nseir12Elie Azoulay13Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), St James' Hospital, Dublin, Ireland; School of Medicine, Trinity College Dublin, Dublin, IrelandInstitute of Intensive Care Medicine, University Hospital Zurich, SwitzerlandMedical ICU, Cochin Hospital, Assistance Publique - Hôpitaux de Paris, Centre, Institut Cochin, INSERM U1016, CNRS UMR8104, Université Paris Cité, Paris, FranceDepartment of Infectious Disease, Faculty of Medicine, Centre for Antimicrobial Optimisation, Imperial College London, London, UK; Department of Critical Care Medicine, Imperial College Healthcare NHS Trust, London, UKDepartment of Intensive Care, Copenhagen University Hospital Gentofte, Hellerup, Denmark; Department of Clinical Medicine, University of Copenhagen, DenmarkSchool of Medicine, University of Glasgow, UKServiço de Medicina Intensiva, Hospital de Santa Maria, ULS Santa Maria, Portugal; Clínica Universitária de Medicina Intensiva, Faculdade de Medicina da Universidade de Lisboa, PortugalHematology and Bone Marrow Transplant Department, University Hospital Santa Maria, ULS Santa Maria, Lisbon, PortugalIntensive Care Unit, Royal Surrey Hospital, Surrey, UK; Faculty of Health and Medical Sciences, University of Surrey, Surrey, UKMedical Intensive Care Unit, Hospital Clínic of Barcelona, Spain; IDIBAPS, University of Barcelona, Barcelona, SpainD'OR Institute for Research and Education, Rio de Janeiro, BrazilIntensive Care Unit, Donostia University Hospital, Biogipuzkoa, Infectious Diseases Area, Respiratory Infection and Antimicrobial Resistance Group, Spain; Centro de Investigacion Biomedica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain; Osakidetza Basque Health Service, Donostialdea Integrated Health Organisation, Microbiology Department, Donostia-San Sebastian 20014, SpainMédecine Intensive Réanimation, CHU de Lille, Lille F-59000, FranceMedical Intensive Care Unit, AP-HP, Saint-Louis Hospital, Paris-Cité University, INSERM UMR1342 Institut de Recherche Saint-Louis, Paris, France; Corresponding author. Medical Intensive Care Unit, AP-HP, Saint Louis University Hospital, Paris, France.Summary: Immunosuppression, characterised by impaired immune function, significantly influences infection risk and ICU admissions in critically ill patients. This manuscript highlights the need for grading criteria to assess pre-existing immunosuppression, considering factors like underlying diseases, immunosuppressive therapies, and clinical outcomes variability. We propose a grading system categorising immunosuppression as mild, moderate, or severe. These criteria, while preliminary, offer a foundation for future refinement. Patients with moderate immunosuppression may require closer infection surveillance, while those with severe immunosuppression might need early immune reconstitution therapies. Prospective studies integrating biomarkers and advanced tools like machine learning are essential to validate and enhance the grading system for clinical use. This approach aims to make immunosuppression assessments more predictive and actionable. This narrative review synthesises current knowledge and provides guidance for individualised management. Effective care requires balancing immunosuppressive treatments with infection prevention, including risk assessments, optimisation, and medication reconciliation. Ultimately, the manuscript advocates for developing robust grading criteria to improve clinical decision-making and outcomes for critically ill immunocompromised patients. Funding: Not receiving any funding.http://www.sciencedirect.com/science/article/pii/S2589537025002329SepsisImmunosuppressionGrading of diseaseICU |
| spellingShingle | Ignacio Martin-Loeches Sascha David Frédéric Pène Louis Kreitmann Lene Russel Kathryn Puxty João Santos Silva Ana Vagos Mata Ben Creagh-Brown Pedro Castro Jorge Salluh Loreto Vidaur-Tello Saad Nseir Elie Azoulay Advocating for the recognition of underlying immunosuppression in critical illness EClinicalMedicine Sepsis Immunosuppression Grading of disease ICU |
| title | Advocating for the recognition of underlying immunosuppression in critical illness |
| title_full | Advocating for the recognition of underlying immunosuppression in critical illness |
| title_fullStr | Advocating for the recognition of underlying immunosuppression in critical illness |
| title_full_unstemmed | Advocating for the recognition of underlying immunosuppression in critical illness |
| title_short | Advocating for the recognition of underlying immunosuppression in critical illness |
| title_sort | advocating for the recognition of underlying immunosuppression in critical illness |
| topic | Sepsis Immunosuppression Grading of disease ICU |
| url | http://www.sciencedirect.com/science/article/pii/S2589537025002329 |
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