Martin-Loeches Ignacio, David Sascha, Pène Frédéric, Kreitmann Louis, Russel Lene, Puxty Kathryn, Silva João Santos, Mata Ana Vagos, Creagh-Brown Ben, Castro Pedro, Salluh Jorge, Vidaur-Tello Loreto, Nseir Saad, Azoulay Elie
Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), St James' Hospital, Dublin, Ireland.
School of Medicine, Trinity College Dublin, Dublin, Ireland.
EClinicalMedicine. 2025 Jun 30;85:103300. doi: 10.1016/j.eclinm.2025.103300. eCollection 2025 Jul.
Immunosuppression, characterised by impaired immune function, significantly influences infection risk and ICU admissions in critically ill patients. This manuscript highlights the need for grading criteria to assess pre-existing immunosuppression, considering factors like underlying diseases, immunosuppressive therapies, and clinical outcomes variability. We propose a grading system categorising immunosuppression as mild, moderate, or severe. These criteria, while preliminary, offer a foundation for future refinement. Patients with moderate immunosuppression may require closer infection surveillance, while those with severe immunosuppression might need early immune reconstitution therapies. Prospective studies integrating biomarkers and advanced tools like machine learning are essential to validate and enhance the grading system for clinical use. This approach aims to make immunosuppression assessments more predictive and actionable. This narrative review synthesises current knowledge and provides guidance for individualised management. Effective care requires balancing immunosuppressive treatments with infection prevention, including risk assessments, optimisation, and medication reconciliation. Ultimately, the manuscript advocates for developing robust grading criteria to improve clinical decision-making and outcomes for critically ill immunocompromised patients.
Not receiving any funding.
免疫抑制以免疫功能受损为特征，显著影响重症患者的感染风险和入住重症监护病房（ICU）的情况。本手稿强调需要有分级标准来评估预先存在的免疫抑制，要考虑基础疾病、免疫抑制治疗以及临床结局变异性等因素。我们提出一种分级系统，将免疫抑制分为轻度、中度或重度。这些标准虽为初步标准，但为未来的完善提供了基础。中度免疫抑制患者可能需要更密切的感染监测，而重度免疫抑制患者可能需要早期免疫重建治疗。整合生物标志物和机器学习等先进工具的前瞻性研究对于验证和完善该分级系统以供临床使用至关重要。这种方法旨在使免疫抑制评估更具预测性和可操作性。本叙述性综述综合了当前知识，并为个体化管理提供指导。有效的护理需要在免疫抑制治疗与感染预防之间取得平衡，包括风险评估、优化和用药核对。最终，本手稿主张制定强有力的分级标准，以改善重症免疫受损患者的临床决策和结局。
未接受任何资金。
