Persistent Inflammation After Sepsis Linked to Higher Mortality
THURSDAY, Aug. 8, 2019 -- About two-thirds of patients who survive hospitalization for sepsis have persistent elevation of inflammation and immunosuppression biomarkers, which is linked to increased mortality, according to a study published online Aug. 7 in JAMA Network Open.
Sachin Yende, M.D., from the Veterans Affairs Pittsburgh Healthcare System, and colleagues enrolled and followed 483 adults who survived a hospitalization for sepsis at 12 U.S. hospitals for up to one year. At five time points during and after hospitalization, circulating levels of inflammation, immunosuppression, hemostasis, endothelial dysfunction, and oxidative stress biomarkers were measured.
The researchers found that elevated high-sensitivity C-reactive protein (hs-CRP) levels were seen in 25.8, 30.2, and 25.6 percent of patients at three, six, and 12 months, respectively; elevated soluble programmed death ligand 1 (sPDL1) levels were seen in 46.4, 44.9, and 49.4 percent of patients, respectively. Two common phenotypes were identified based on hs-CRP and sPDL1 levels: high hs-CRP and sPDL1 (68.3 percent) and normal hs-CRP and sPDL1 (30.0 percent). Those with the hyperinflammation and immunosuppression phenotype versus normal phenotype had increased one-year mortality (odds ratio, 8.26), six-month all-cause readmission or mortality (hazard ratio, 1.53), and six-month readmission or mortality attributable to cardiovascular disease or cancer (hazard ratios, 5.07 and 5.15, repectively).
"The dysregulated host immune response activated during sepsis may persist up to one year," the authors write. "Our findings suggest that long-term immunomodulation strategies should be explored in patients hospitalized with sepsis."
Several authors disclosed financial ties to the biopharmaceutical industry; one author has patents pending for work related to sepsis.
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Posted: August 2019