Vaidie Julien, Demiselle Julien, Gabriel Anthony, Guillon Antoine, Peju Edwige, Pène Frédéric, Szychowiak Piotr, Delange Boris, Guillot Pauline, Lacherade Jean-Claude, Asfar Pierre, Zalucky Ann, Vignon Philippe, Evrard Bruno, François Bruno
Réanimation Polyvalente, CHU Dupuytren, Limoges, France.
CRBS (Centre de Recherche en Biomédecine de Strasbourg), FMTS (Fédération de Médecine Translationnelle de Strasbourg), INSERM UMR 1260, Nanomédecine Régénérative, Nouvel Hôpital Civil, Université de Strasbourg, Strasbourg, France.
Intensive Care Med. 2025 Aug;51(8):1442-1452. doi: 10.1007/s00134-025-08024-7. Epub 2025 Jul 16.
Decision-making for management of immunosuppressive drugs in solid organ transplant patients admitted to the ICU remains controversial. This study aimed to evaluate the impact of a temporary suspension strategy (interruption of immunosuppressive drugs > 24h) on day-90 mortality and ICU-acquired infections.
This multicenter observational retrospective study conducted in solid organ transplant patients admitted to nine ICUs used a Bayesian approach with priors based on a belief elicitation process conducted among a panel of experts.
Among 591 enrolled patients, suspension strategy was used in 34% of them, during a median period of 5 days [IQR: 3-10]. This approach was more common in patients admitted for sepsis (38%) or COVID-19 (49%) than for non-septic causes (24%) (p < 0.001). Overall, day-90 mortality reached 30%, and Bayesian analysis revealed substantial uncertainty with an OR at 1.13 (95% Credible Interval (CrI): 0.74-1.70), and a 15% probability of a beneficial effect. In the subgroup of patients with sepsis, OR was at 0.90 (95% CrI: 0.55-1.55), with a 50% probability of a beneficial effect. ICU-acquired infections occurred in 26% of patients. The suspension strategy indicated a potential benefit, both in the entire cohort, with a 73% probability of a beneficial effect [OR: 0.74 (95% CrI: 0.49-1.15)], and in the subgroup of sepsis patients with a 78% probability of beneficial effect [OR 0.70 (95% CrI, 0.42-1.16)].
Temporary suspension of immunosuppressive drugs may reduce the risk of ICU-acquired infections, with a true uncertainty on day-90 mortality. Prospective studies are warranted to confirm these results.
对于入住重症监护病房（ICU）的实体器官移植患者，免疫抑制药物管理的决策仍存在争议。本研究旨在评估临时停药策略（免疫抑制药物中断>24小时）对90天死亡率和ICU获得性感染的影响。
这项多中心观察性回顾性研究在入住9个ICU的实体器官移植患者中进行，采用贝叶斯方法，先验概率基于在一组专家中进行的信念诱导过程。
在591名入组患者中，34%的患者采用了停药策略，中位时间为5天[四分位间距：3 - 10]。与非脓毒症原因（24%）相比，这种方法在因脓毒症（38%）或COVID - 19（49%）入院的患者中更为常见（p < 0.001）。总体而言，90天死亡率达到30%，贝叶斯分析显示存在很大不确定性，优势比为1.13（95%可信区间（CrI）：0.74 - 1.70），有益效果的概率为15%。在脓毒症患者亚组中，优势比为0.90（95% CrI：0.55 - 1.55），有益效果的概率为50%。26%的患者发生了ICU获得性感染。停药策略显示出潜在益处，在整个队列中有益效果的概率为73%[优势比：0.74（95% CrI：0.49 - 1.15）]，在脓毒症患者亚组中有益效果的概率为78%[优势比0.70（95% CrI，0.42 - 1.16）]。
免疫抑制药物的临时停药可能会降低ICU获得性感染的风险，但对90天死亡率存在真正的不确定性。有必要进行前瞻性研究来证实这些结果。
