Critical illnesses represent a significant physiological assault that triggers changes in the patient's immune system, resulting in an immunopotentiating response (systemic inflammatory response syndrome, SIRS) and an immunosuppressive response (compensatory anti-inflammatory response syndrome, CARS). The balance between SIRS and CARS is essential for the patient to return to a state of immune homeostasis and accelerate the healing process. However, when CARS is disproportionately intense, it leads to a state of immunoparalysis, which predisposes the patient to vulnerability to opportunistic infections, associated with a peak in late mortality. The majority of patients admitted to the ICU are considered immunocompetent. However, the investigators suspect that a significant proportion of them exhibit predominance of CARS and a state of functional immunosuppression. There is currently no diagnostic test to determine whether a patient is functionally immunocompetent at a specific point in time. The goal of this observational study is to learn about the immune system dysfunction occurring in critical illness. The main questions it aims to answer are: * What is the prevalence of immune system dysfunction in critical illness? * Does immune system dysfunction affect multiple organ failure trajectory and mortality in critical illness? * Is immune system dysfunction related to an increased risk of opportunistic hospital-acquired infections in critical illness? * Is immune system dysfunction related to age, fragility, nutritional status or previous comorbidities in critical illness? To answer these questions, the investigators will prospectively study a population of critically ill patients, defined by the presence of organ failure. The investigators will analyse a panel of genes and molecules involved in immunological synapse, using peripheral blood samples at different moments of the evolution of critical illness. Based on the analysis, the investigators will classify the patients' functional immune status and correlate it with the outcomes.
Study Type
OBSERVATIONAL
Enrollment
100
We will collect blood samples from the patients included in the study on ICU days 1, 3 and 5. We will measure gene expression (mRNA) and plasma levels of various elements involved in the immunological synapse.
Hospital Universitario Río Hortega
Valladolid, Spain
RECRUITINGProportion of patients with a functional immunosuppression signature
Number of patients with organ failure exhibiting an early transcriptomic signature denoting depression of the immunological synapse.
Time frame: 5 days
Mortality (28-day)
Number of non-surviving patients in the groups with and without an early functional immunosuppression signature.
Time frame: 28 days
Hospital-Acquired Infection (28-day)
Number of patients developing hospital-acquired infections in the groups with and without an early functional immunosuppression signature.
Time frame: 28 days
Organ Failure Resolution (28-day)
Number of patients with organ failure resolution in the groups with and without an early functional immunosuppression signature.
Time frame: 28 days
Mortality (90-day)
Number of non-surviving patients in the groups with and without an early functional immunosuppression signature.
Time frame: 90 days
Hospital-Acquired Infection (90-day)
Number of patients developing hospital-acquired infections in the groups with and without an early functional immunosuppression signature.
Time frame: 90 days
Duration of hospitalization in the ICU
Length of stay in the ICU in the groups with and without an early functional immunosuppression signature.
Time frame: 90 days
Proportion of patients requiring organ support
Number of patients who require organ support (mechanical ventilation, vasopressors, renal replacement therapy, extracorporeal membrane oxygenation,...) in the groups with and without an early functional immunosuppression signature.
Time frame: 90 days
Proportion of patients with early cardiac dysfunction
Number of patients who develop early cardiac dysfunction, as assessed by echocardiography, in the groups with and without an early functional immunosuppression signature.
Time frame: 5 days
Proportion of patients with Herpesviridae reactivation
Number of patients who develop Herpesviridae reactivation during ICU admission, in the groups with and without an early functional immunosuppression signature.
Time frame: 90 days
Proportion of patients with ICU-related complications
Number of patients who develop ICU-related complications during ICU admission, including ICU-acquired weakness, delirium, thrombosis or bleeding, in the groups with and without an early functional immunosuppression signature.
Time frame: 90 days
Proportion of patients with post-intensive care syndrome
Number of patients who develop post-intensive care syndrome, in the groups with and without an early functional immunosuppression signature.
Time frame: 90 days
Luis Mariano Tamayo-Lomas, MD, PhD
CONTACT
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