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Severe sepsis can lead to impairment of immune system, study suggests

Date:
December 22, 2011
Source:
JAMA and Archives Journals
Summary:
An analysis of lung and spleen tissue from patients who died of sepsis revealed certain biochemical, cellular and histological findings that were consistent with immunosuppression, according to a new study.

An analysis of lung and spleen tissue from patients who died of sepsis revealed certain biochemical, cellular and histological findings that were consistent with immunosuppression, according to a study in the December 21 issue of JAMA.

"Sepsis is responsible for more than 225,000 deaths annually in the United States. Developing new therapies for sepsis has been particularly challenging, with more than 25 unsuccessful drug trials. Characterized by an initial intense inflammatory response or 'cytokine storm,' patients with sepsis may present with fever, shock, altered mental status, and organ dysfunction," according to background information in the article. "Whether this hyperinflammatory phase is followed by immunosuppression is controversial. Animal studies suggest that multiple immune defects occur in sepsis, but data from humans remain conflicting."

Jonathan S. Boomer, Ph.D., of the Washington University School of Medicine, St. Louis, and colleagues conducted a study to assess evidence of immunosuppression in sepsis and to determine mechanisms that might be responsible for the presumed impaired immunity. For the study, to characterize their immune status at the time of death (2009-2011), postmortem spleen and lung tissue harvest was performed on 40 patients who died in intensive care units (ICUs) with active severe sepsis. Control spleens (n = 29) were obtained from patients who were declared brain-dead or had emergency splenectomy due to trauma; control lungs (n = 20) were obtained from transplant donors or from lung cancer resections. Various tests were performed on the tissue samples to identify potential mechanisms of immune dysfunction.

The average ages of patients with sepsis and controls were 72 and 53 years, respectively. The median (midpoint) number of ICU days for patients with sepsis was 8, while control patients were in ICUs for 4 or fewer days. The median duration of sepsis was 4 days. Among the results of the researchers were that

patients who died of sepsis had biochemical, flow cytometric (cell analysis), and immunohistochemical (process of detecting antigens in cells of a tissue section) findings that were consistent with immunosuppression, compared with the patients who died of nonsepsis causes.

"The present study has a number of important therapeutic implications. Most investigative agents in sepsis have been directed at blocking inflammation and immune activation. Although such therapies may be successful if applied early, they may be harmful if applied later in the immunosuppressive phase. As supportive therapies of sepsis have improved, early deaths have decreased and most patients enter a more protracted phase, with evidence of impaired immunity made manifest by infections with relatively avirulent organisms. An important part of implementing more targeted therapies will be to accurately determine the immune status of individual patients during their disease," the authors write.


Story Source:

The above story is based on materials provided by JAMA and Archives Journals. Note: Materials may be edited for content and length.


Journal Reference:

  1. J. S. Boomer, K. To, K. C. Chang, O. Takasu, D. F. Osborne, A. H. Walton, T. L. Bricker, S. D. Jarman, D. Kreisel, A. S. Krupnick, A. Srivastava, P. E. Swanson, J. M. Green, R. S. Hotchkiss. Immunosuppression in Patients Who Die of Sepsis and Multiple Organ Failure. JAMA: The Journal of the American Medical Association, 2011; 306 (23): 2594 DOI: 10.1001/jama.2011.1829

Cite This Page:

JAMA and Archives Journals. "Severe sepsis can lead to impairment of immune system, study suggests." ScienceDaily. ScienceDaily, 22 December 2011. <www.sciencedaily.com/releases/2011/12/111220172624.htm>.
JAMA and Archives Journals. (2011, December 22). Severe sepsis can lead to impairment of immune system, study suggests. ScienceDaily. Retrieved April 16, 2014 from www.sciencedaily.com/releases/2011/12/111220172624.htm
JAMA and Archives Journals. "Severe sepsis can lead to impairment of immune system, study suggests." ScienceDaily. www.sciencedaily.com/releases/2011/12/111220172624.htm (accessed April 16, 2014).

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