Tremblay Jan-Alexis, Peron Florian, Kreitmann Louis, Textoris Julien, Brengel-Pesce Karen, Lukaszewicz Anne-Claire, Quemeneur Laurence, Vedrine Christophe, Tan Lionel K, Venet Fabienne, Rimmele Thomas, Monneret Guillaume
EA 7426 "Pathophysiology of Injury-Induced Immunosuppression" (Université Claude Bernard Lyon 1 - Hospices Civils de Lyon - bioMérieux), Joint Research Unit HCL-bioMérieux, Herriot Hospital, 5 place d'Arsonval, 69003, Lyon, France.
Critical Care Service, Hôpital Maisonneuve-Rosemont, 5415 Boulevard de l'Assomption, Montréal, H1T2M4, Canada.
Ann Intensive Care. 2022 Aug 17;12(1):76. doi: 10.1186/s13613-022-01051-3.
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 CD16) neutrophils and serum IL-10 level. In the cohort of interest (n = 189), incidence of secondary infection at day 30 increased from 8% for patients with REALIST score of 0 to 46% in patients with a score of 3 abnormal parameters, measured ad D5-7. When adjusted for a priori identified clinical risk factors for secondary infection (SOFA score and invasive mechanical ventilation at D5-7), a higher REALIST score was independently associated with increased risk of secondary infection (42 events (22.2%), adjusted HR 3.22 (1.09-9.50), p = 0.034) and mortality (10 events (5.3%), p = 0.001).
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.
尽管多项个体免疫参数已被证明可预测危重症后二次感染的发生，但关于此类免疫监测测试的选择、时机和临床效用仍存在重大问题。
作为REALISM研究的一项子研究，开发了REALIST评分，作为一种实用方法，使用一组相对容易获得且技术可靠的生物标志物，帮助临床医生更好地识别和分层二次感染高危患者。
这是一项针对严重创伤、大手术或脓毒症/脓毒性休克后入院的危重症成人进行免疫谱分析的单中心前瞻性队列研究的子研究。对于REALIST评分，基于其临床适用性和技术可靠性预先选择了五个免疫参数。评估了不同参数及参数组合的预测能力。主要关注的结果是30天内二次感染的发生情况。
在排除统计学上冗余且预测性差的参数后，REALIST评分中保留了三个参数：mHLA-DR、未成熟（CD10 CD16）中性粒细胞百分比和血清IL-10水平。在感兴趣的队列（n = 189）中，第30天二次感染的发生率从REALIST评分为0的患者的8%增加到有3个异常参数评分的患者的46%（在第5 - 7天测量）。在对预先确定的二次感染临床风险因素（序贯器官衰竭评估（SOFA）评分和第5 - 7天有创机械通气）进行校正后，较高的REALIST评分与二次感染风险增加（42例事件（22.2%），校正风险比（HR）3.22（1.09 - 9.50），p = 0.034）和死亡率（10例事件（5.3%），p = 0.001）独立相关。
我们推导并展示了REALIST评分，这是一种简单实用的分层策略，为临床医生提供了对患者免疫状态的清晰评估。这个新工具有助于优化对这些个体的护理，并可能有助于设计未来的免疫刺激策略试验。
