Immunosuppression (weakening of the immune system) negatively affects the outcomes of critically ill patients worldwide. The causes of this condition are diverse: cancer, transplantation, chemotherapy, or severe trauma/infection acquired in the intensive care unit itself. Despite its deadly potential, immunosuppression in the ICU receives less attention or is not accurately classified, which hinders targeted treatment.
A comprehensive review published in the journal The Lancet eClinicalMedicine proposes a standardized classification of immunosuppression based on clinical and laboratory biomarkers. The main goal of this research is to significantly improve patients’ condition by implementing personalized therapy and preventing infection, which will bring about a significant change in intensive care.
Critically ill patients with immunosuppression have a significantly higher risk of secondary infections, prolonged treatment in the intensive care unit, and increased mortality. For example, severe fungal and viral infections are common in hematological oncology patients in the ICU. Such cases confirm that managing immune dysfunction in these patients presents a particular difficulty.
Experts note that the severity and type of immune disorder vary widely, which critically affects the risk of infection and the patient’s survival. The problem is that existing intensive care assessment systems do not adequately account for the diversity of this immune dysfunction.
Classification of Immunosuppression: A New Structural Framework
The new system divides immunosuppression into three categories: mild, moderate, and severe. Markers used for assessment include lymphocyte counts, monocytic HLA-DR expression, and doses of administered corticosteroids. For example:
Mild: Immune function is slightly impaired (in one component) and is not life-threatening.
Moderate: Affects multiple immune mechanisms, significantly increasing the risk of severe infections.
Severe: Both innate and acquired immunity are impaired, directly leading to fatal infections.
This classification of immunosuppression takes into account that immune status fluctuates in a critical state, which is why continuous monitoring is needed so that treatment can be tailored to the patient’s individual needs.
The treatment of immunosuppressed patients requires a multidisciplinary approach that considers their underlying disease, potential drug interactions, and pre-existing infections. A crucial role is assigned to infection prevention measures, such as isolation, the use of HEPA (High Efficiency Particulate Air) filters, and targeted prophylaxis against bacterial, fungal, and viral pathogens.
Promising immunotherapies such as interleukin-7, interferon-gamma, and immune checkpoint inhibitors offer great hope for restoring immune function, especially in patients suffering from sepsis. But the safe use of these agents requires an accurate assessment of the patient’s condition using immune biomarkers before treatment.
A better understanding of the changeable nature of immunosuppression will improve clinical decisions and facilitate the integration of precision medicine into critical care. With this approach, it will be possible to reduce morbidity and mortality caused by infection while optimizing the use of resources.
Source: The Lancet eClinicalMedicine
