Dysregulated Immunity and Immunotherapy after Sepsis

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  • Dijoia B. Darden
    Department of Surgery, College of Medicine, University of Florida, Gainesville, FL 32610, USA
  • Lauren S. Kelly
    Department of Surgery, College of Medicine, University of Florida, Gainesville, FL 32610, USA
  • Brittany P. Fenner
    Department of Surgery, College of Medicine, University of Florida, Gainesville, FL 32610, USA
  • Lyle L. Moldawer
    Department of Surgery, College of Medicine, University of Florida, Gainesville, FL 32610, USA
  • Alicia M. Mohr
    Department of Surgery, College of Medicine, University of Florida, Gainesville, FL 32610, USA
  • Philip A. Efron
    Department of Surgery, College of Medicine, University of Florida, Gainesville, FL 32610, USA

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<jats:p>Implementation of protocolized surveillance, diagnosis, and management of septic patients, and of surgical sepsis patients in particular, is shown to result in significantly increased numbers of patients surviving their initial hospitalization. Currently, most surgical sepsis patients will rapidly recover from sepsis; however, many patients will not rapidly recover, but instead will go on to develop chronic critical illness (CCI) and experience dismal long-term outcomes. The elderly and comorbid patient is highly susceptible to death or CCI after sepsis. Here, we review aspects of the Persistent Inflammation, Immunosuppression, and Catabolism Syndrome (PICS) endotype to explain the underlying pathobiology of a dysregulated immune system in sepsis survivors who develop CCI; then, we explore targets for immunomodulatory therapy.</jats:p>

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