Profiling the dysregulated immune response in sepsis: overcoming challenges to achieve the goal of precision medicine.

Alberto Garcia-Salido, Fabienne Venet, Jesus F Bermejo-Martin, Ignacio Rubio, Marcin Osuchowski, Tomasz Skirecki, Martin Sebastian Winkler, Manu Shankar-Hari, Jean-Marc Cavaillon, Guillaume Monneret, Antoni Torres, Michael Bauer, Frank M Brunkhorst, Joerg C Schefold, Massimo Girardis, Gunnar Lachmann, Ignacio Martin-Loeches, Stefanie B Flohé, Raquel Almansa Mora, Brendon P Scicluna, Andrea Cossarizza, Evangelos J Giamarellos-Bourboulis, Matthijs Kox, Sara Cajander, Markus A Weigand

Journal: The Lancet. Respiratory medicine 2024;12(4):305-322

PMID: 38142698

Abstract

Sepsis is characterised by a dysregulated host immune response to infection. Despite recognition of its significance, immune status monitoring is not implemented in clinical practice due in part to the current absence of direct therapeutic implications. Technological advances in immunological profiling could enhance our understanding of immune dysregulation and facilitate integration into clinical practice. In this Review, we provide an overview of the current state of immune profiling in sepsis, including its use, current challenges, and opportunities for progress. We highlight the important role of immunological biomarkers in facilitating predictive enrichment in current and future treatment scenarios. We propose that multiple immune and non-immune-related parameters, including clinical and microbiological data, be integrated into diagnostic and predictive combitypes, with the aid of machine learning and artificial intelligence techniques. These combitypes could form the basis of workable algorithms to guide clinical decisions that make precision medicine in sepsis a reality and improve patient outcomes.

Copyright © 2024 Elsevier Ltd. All rights reserved.

Address: Department of Infectious Diseases, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.; Department of Intensive Care Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, Netherlands.; Department of Applied Biomedical Science, Faculty of Health Sciences, Mater Dei hospital, University of Malta, Msida, Malta; Centre for Molecular Medicine and Biobanking, University of Malta, Msida, Malta.; Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany.; Department of Cell Biology, Genetics, Histology and Pharmacology, University of Valladolid, Valladolid, Spain.; Department of Trauma, Hand, and Reconstructive Surgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.; St James's Hospital, Dublin, Ireland; Hospital Clinic, Institut D'Investigacions Biomediques August Pi i Sunyer, Universidad de Barcelona, Barcelona, Spain.; Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Anesthesiology and Operative Intensive Care Medicine, Berlin, Germany.; Department of Intensive Care and Anesthesiology, University Hospital of Modena, Modena, Italy.; Hospital Infantil Universitario Niño Jesús, Pediatric Critical Care Unit, Madrid, Spain.; Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany.; Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany; Integrated Research and Treatment Center, Center for Sepsis Control and Care, Jena University Hospital, Jena, Germany.; Pulmonology Department. Hospital Clinic of Barcelona, University of Barcelona, Ciberes, IDIBAPS, ICREA, Barcelona, Spain.; Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, Modena, Italy.; Immunology Laboratory, Hôpital E Herriot - Hospices Civils de Lyon, Lyon, France; Université Claude Bernard Lyon-1, Hôpital E Herriot, Lyon, France.; Institut Pasteur, Paris, France.; Centre for Inflammation Research, Institute of Regeneration and Repair, The University of Edinburgh, Edinburgh, UK.; 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece.; Department of Anesthesiology and Intensive Care, Universitätsmedizin Göttingen, Göttingen, Germany.; Department of Translational Immunology and Experimental Intensive Care, Centre of Postgraduate Medical Education, Warsaw, Poland.; Ludwig Boltzmann Institute for Traumatology, The Research Center in Cooperation with AUVA, Vienna, Austria.; Instituto de Investigación Biomédica de Salamanca, Salamanca, Spain; School of Medicine, Universidad de Salamanca, Salamanca, Spain; Centro de Investigación Biomédica en Red en Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain.; Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.; Immunology Laboratory, Hôpital E Herriot - Hospices Civils de Lyon, Lyon, France; Centre International de Recherche en Infectiologie, Inserm U1111, CNRS, UMR5308, Ecole Normale Supeérieure de Lyon, Universiteé Claude Bernard-Lyon 1, Lyon, France. Electronic address: [email protected].
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