Advocating for the recognition of underlying immunosuppression in critical illness
Ignacio Martín‐Loeches, Sascha David, Frédéric Pène, Louis Kreitmann, Lene Russel, Kathryn Puxty, João Santos Silva, Ana Vagos Mata, Ben Creagh‐Brown, Pedro Castro, Jorge I. Salluh, Loreto Vidaur-Tello, Saad Nseir, Élie Azoulay
Abstract
Immunosuppression, characterised by impaired immune function, significantly influences infection risk and ICU admissions in critically ill patients. This manuscript highlights the need for grading criteria to assess pre-existing immunosuppression, considering factors like underlying diseases, immunosuppressive therapies, and clinical outcomes variability. We propose a grading system categorising immunosuppression as mild, moderate, or severe. These criteria, while preliminary, offer a foundation for future refinement. Patients with moderate immunosuppression may require closer infection surveillance, while those with severe immunosuppression might need early immune reconstitution therapies. Prospective studies integrating biomarkers and advanced tools like machine learning are essential to validate and enhance the grading system for clinical use. This approach aims to make immunosuppression assessments more predictive and actionable. This narrative review synthesises current knowledge and provides guidance for individualised management. Effective care requires balancing immunosuppressive treatments with infection prevention, including risk assessments, optimisation, and medication reconciliation. Ultimately, the manuscript advocates for developing robust grading criteria to improve clinical decision-making and outcomes for critically ill immunocompromised patients. Funding: Not receiving any funding.