Occurrence of marked sepsis-induced immunosuppression in pediatric septic shock: a pilot study

被引：31

作者：

Remy, Solenn ^{[1
]}

Kolev-Descamps, Karine ^{[1
]}

Gossez, Morgane ^{[2
]}

Venet, Fabienne ^{[2
,3
]}

Demaret, Julie ^{[2
]}

Javouhey, Etienne ^{[1
]}

Monneret, Guillaume ^{[2
,3
]}

机构：

[1] Mother & Children Univ Hosp, Hosp Civils Lyon, Paediat Intens Care Unit, 59 Blvd Pinel, F-69500 Bron, France

[2] E Herriot Hosp, Hosp Civils Lyon, Immunol Lab, F-69003 Lyon, France

[3] Univ Claude Bernard Lyon 1, E Herriot Hosp, BioMerieux Hosp Civils Lyon, EA 7426,Pathophysiol Injury Induced Immunosuppres, F-69003 Lyon, France

来源：

ANNALS OF INTENSIVE CARE | 2018年 / 8卷

关键词：

Septic shock; Immunosuppression induced; Children; CRITICALLY-ILL CHILDREN; HLA-DR EXPRESSION; NOSOCOMIAL INFECTION; MORTALITY; DYSFUNCTIONS; PREDICTS; CELLS; TRIAL;

D O I：

10.1186/s13613-018-0382-x

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

Background: While the process of sepsis-induced immunosuppression is now well described in adults, very little information is available on immune functions in pediatric sepsis. The current study investigated this in children with septic shock by performing immunomonitoring, including both innate (monocyte human leukocyte antigen-DR, mHLA-DR, expression) and adaptive immunity (lymphocyte subsets count), as well as cytokine concentrations (IL-6, IL-8, IL-10, IL-1Ra, TNF-alpha, IFN-gamma). Subsequent objectives were to assess the associations between inflammatory response, potential immunosuppression and secondary acquired infection occurrence. Methods: Single-center prospective observational study, including children aged between 1 month and 18 years admitted to pediatric intensive care unit (PICU) for septic shock. Age-matched controls were children hospitalized for elective surgery without any infectious criteria. Blood was sampled at day 1-2, 3-5, and 7-9 after sepsis onset. mHLA-DR and lymphocyte subsets count were measured by flow cytometry and cytokine concentrations by Luminex technology. Results: A total of 26 children and 30 controls were included. Patients had lymphopenia, and mHLA-DR levels were significantly lower than controls at each time point (p < 0.0001). All cytokines peaked at day 1-2. Children with secondary acquired infection had lower day 3-5 mHLA-DR and higher pro-inflammatory cytokine concentrations (IL-6, IL-8 and TNF-alpha) at day 1-2 compared to children without secondary acquired infection. Conclusions: The higher initial inflammatory cytokine production was, the more innate immunity was altered, while evaluated by low mHLA-DR expression. Children with decreased mHLA-DR expression developed more secondary acquired infections. Upon confirmation in multicenter cohorts, these results pave the way for immunostimulation for the most immunosuppressed children in order to prevent nosocomial infections in PICU.

引用

页数：10