title: Sepsis severe or septic shock: outcome according to immune status and immunodeficiency profile.
abstract: OBJECTIVE
  This study evaluated the influence of the immune profile on the outcome at day 28 (D28) of patients admitted to the ICU for septic shock or severe sepsis.
  
  
  METHODS
  We conducted an observational study using a prospective multicenter database and included all patients admitted to 11 ICUs for severe sepsis or septic shock from January 1997 to August 2011. Seven profiles of immunodeficiency were defined. The prognostic analysis used a competitive risk model (Fine and Gray), in which being alive at ICU or hospital discharge before D28 competed with death.
  
  
  RESULTS
  Among the 1,981 included patients, 607 (31%) were immunocompromised (including nonneutropenic solid tumor [19.6%], nonneutropenic hematologic malignancies [26.3%], and all-cause neutropenia [28%]). Compared with immunocompetent patients, immunocompromised patients were younger, with less comorbidity, were more often admitted for medical reasons, and presented less often with septic shock. The D28 crude mortality was 31.3% in immunocompromised patients and 28.8% in immunocompetent patients (P = .26). However, after adjustment for other prognostic factors, immunodeficiency was an independent risk factor for death at D28 (subdistribution hazard ratio [sHR], 1.37; 95% CI, 1.12-1.67). The immunodeficiency profiles independently associated with death were AIDS (sHR = 1.9), non-neutropenic solid tumor (sHR = 1.8), nonneutropenic hematologic malignancies (sHR = 1.4), and all-cause neutropenia (sHR = 1.7).
  
  
  CONCLUSIONS
  Immunodeficiency is common in patients with severe sepsis or septic shock. Despite a similar crude mortality, immunodeficiency was associated with an increased risk of short-term mortality after multivariate analysis. Neutropenia and specific, but not all, profiles of immunodeficiency were independently associated with an increased risk of death.
authors.affiliation: From the A. Michallon University Hospital, INSERM U823 and Joseph Fourier University, Grenoble.
authors.forename: Violaine
authors.initials: V
authors.lastname: Tolsma
authors.affiliation: From the A. Michallon University Hospital, INSERM U823 and Joseph Fourier University, Grenoble.
authors.forename: Carole
authors.initials: C
authors.lastname: Schwebel
authors.affiliation: Saint-Louis University Hospital, Paris.
authors.forename: Elie
authors.initials: E
authors.lastname: Azoulay
authors.affiliation: Saint-Etienne University Hospital, Saint-Etienne.
authors.forename: Michael
authors.initials: M
authors.lastname: Darmon
authors.affiliation: Gabriel Montpied University Hospital, Clermont-Ferrand.
authors.forename: Bertrand
authors.initials: B
authors.lastname: Souweine
authors.affiliation: From the A. Michallon University Hospital, INSERM U823 and Joseph Fourier University, Grenoble.
authors.forename: Aurélien
authors.initials: A
authors.lastname: Vesin
authors.affiliation: Gonesse Hospital Gonesse.
authors.forename: Dany
authors.initials: D
authors.lastname: Goldgran-Toledano
authors.affiliation: From the A. Michallon University Hospital, INSERM U823 and Joseph Fourier University, Grenoble.
authors.forename: Maxime
authors.initials: M
authors.lastname: Lugosi
authors.affiliation: Dourdan Hospital Dourdan.
authors.forename: Samir
authors.initials: S
authors.lastname: Jamali
authors.affiliation: Hyeres Hospital Hyeres.
authors.forename: Christine
authors.initials: C
authors.lastname: Cheval
authors.affiliation: Delafontaine Hospital, Saint-Denis.
authors.forename: Christophe
authors.initials: C
authors.lastname: Adrie
authors.affiliation: Cayenne Hospital French Guyana.
authors.forename: Hatem
authors.initials: H
authors.lastname: Kallel
authors.affiliation: A. Beclere Hospital, Clamart.
authors.forename: Adrien
authors.initials: A
authors.lastname: Descorps-Declere
authors.affiliation: Saint-Joseph Hospital Network, Paris; IAME UMR 1137, University Paris Diderot, Sorbonne Paris Cité, F-75018 Paris, France.
authors.forename: Maïté
authors.initials: M
authors.lastname: Garrouste-Orgeas
authors.affiliation: AP-HP, Bichat Hospital Medical and Infectious Diseases ICU, F-75018, Paris; IAME UMR 1137, University Paris Diderot, Sorbonne Paris Cité, F-75018 Paris, France.
authors.forename: Lila
authors.initials: L
authors.lastname: Bouadma
authors.affiliation: From the A. Michallon University Hospital, INSERM U823 and Joseph Fourier University, Grenoble; AP-HP, Bichat Hospital Medical and Infectious Diseases ICU, F-75018, Paris; IAME UMR 1137, University Paris Diderot, Sorbonne Paris Cité, F-75018 Paris, France. Electronic address: Jean-francois.timsit@bch.aphp.fr.
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Timsit
mesh_terms: D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007109:Immunity; D016867:Immunocompromised Host / Q000276:immunology*; D015994:Incidence; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D012772:Shock, Septic / Q000276:immunology* / Q000401:mortality