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Original Research: Critical Care |

Sepsis Severe or Septic ShockImmune Status and Outcome of Severe Sepsis: Outcome According to Immune Status and Immunodeficiency Profile

Violaine Tolsma, MD; Carole Schwebel, MD, PhD; Elie Azoulay, MD, PhD; Michael Darmon, MD, PhD; Bertrand Souweine, MD, PhD; Aurélien Vesin, MSc; Dany Goldgran-Toledano, MD; Maxime Lugosi, MD; Samir Jamali, MD; Christine Cheval, MD; Christophe Adrie, MD, PhD; Hatem Kallel, MD; Adrien Descorps-Declere, MD; Maïté Garrouste-Orgeas, MD, PhD; Lila Bouadma, MD, PhD; Jean-François Timsit, MD, PhD
Author and Funding Information

From the A. Michallon University Hospital (Drs Tolsma, Schwebel, Lugosi, and Timsit and Ms Vesin), INSERM U823 and Joseph Fourier University, Grenoble; Saint-Louis University Hospital (Dr Azoulay), Paris; Saint-Etienne University Hospital (Dr Darmon), Saint-Etienne; Gabriel Montpied University Hospital (Dr Souweine), Clermont-Ferrand; Gonesse Hospital (Dr Goldgran-Toledano), Gonesse; Dourdan Hospital (Dr Jamali), Dourdan; Hyeres Hospital (Dr Cheval), Hyeres; Delafontaine Hospital (Dr Adrie), Saint-Denis; Cayenne Hospital (Dr Kallel), French Guyana; A. Beclere Hospital (Dr Descorps-Declere), Clamart; Saint-Joseph Hospital Network (Dr Garrouste-Orgeas), Paris; AP-HP, Bichat Hospital (Drs Bouadma and Timsit), Medical and Infectious Diseases ICU, F-75018, Paris; IAME (Drs Garrouste-Orgeas, Bouadma, and Timsit), UMR 1137, University Paris Diderot, Sorbonne Paris Cité, F-75018 Paris, France.

CORRESPONDENCE TO: Jean-François Timsit, MD, PhD, Medical and Infectious Diseases ICU, Bichat Hospital, Paris, France 75018; e-mail: Jean-francois.timsit@bch.aphp.fr


FUNDING/SUPPORT: The authors have reported to CHEST that no funding was received for this study.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2014;146(5):1205-1213. doi:10.1378/chest.13-2618
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OBJECTIVES:  This study evaluated the influence of the immune profile on the outcome at day 28 (D28) of patients admitted to the ICU for septic shock or severe sepsis.

METHODS:  We conducted an observational study using a prospective multicenter database and included all patients admitted to 11 ICUs for severe sepsis or septic shock from January 1997 to August 2011. Seven profiles of immunodeficiency were defined. The prognostic analysis used a competitive risk model (Fine and Gray), in which being alive at ICU or hospital discharge before D28 competed with death.

RESULTS:  Among the 1,981 included patients, 607 (31%) were immunocompromised (including nonneutropenic solid tumor [19.6%], nonneutropenic hematologic malignancies [26.3%], and all-cause neutropenia [28%]). Compared with immunocompetent patients, immunocompromised patients were younger, with less comorbidity, were more often admitted for medical reasons, and presented less often with septic shock. The D28 crude mortality was 31.3% in immunocompromised patients and 28.8% in immunocompetent patients (P = .26). However, after adjustment for other prognostic factors, immunodeficiency was an independent risk factor for death at D28 (subdistribution hazard ratio [sHR], 1.37; 95% CI, 1.12-1.67). The immunodeficiency profiles independently associated with death were AIDS (sHR = 1.9), non-neutropenic solid tumor (sHR = 1.8), nonneutropenic hematologic malignancies (sHR = 1.4), and all-cause neutropenia (sHR = 1.7).

CONCLUSIONS:  Immunodeficiency is common in patients with severe sepsis or septic shock. Despite a similar crude mortality, immunodeficiency was associated with an increased risk of short-term mortality after multivariate analysis. Neutropenia and specific, but not all, profiles of immunodeficiency were independently associated with an increased risk of death.

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