title: Persistent Inflammation, Immunosuppression and Catabolism Syndrome.
abstract: Following advances in critical care, in-hospital multiple organ failure-related mortality is declining. Consequently, incidence of chronic critical illness is increasing. These patients linger in the intensive care unit, have high resource utilization, and poor long-term outcomes. Within this population, the authors propose that a substantial subset of patients have a new phenotype: persistent inflammation, immunosuppression, and catabolism syndrome. There is evidence that myelodysplasia with expansion of myeloid-derived suppressor cells, innate and adaptive immune suppression, and protein catabolism with malnutrition are major contributors. Optimal care of these patients will require novel multimodality interventions.
authors.affiliation: Department of Surgery, Sepsis and Critical Illness Research Center, University of Florida College of Medicine, 1600 Southwest Archer Road, PO Box 100019, Gainesville, FL 32610-0019, USA.
authors.forename: Juan C
authors.initials: JC
authors.lastname: Mira
authors.affiliation: Department of Surgery, Sepsis and Critical Illness Research Center, University of Florida College of Medicine, 1600 Southwest Archer Road, Room 6116, PO Box 100286, Gainesville, FL 32610-0286, USA.
authors.forename: Scott C
authors.initials: SC
authors.lastname: Brakenridge
authors.affiliation: Department of Surgery, Sepsis and Critical Illness Research Center, University of Florida College of Medicine, 1600 Southwest Archer Road, Room 6116, PO Box 100286, Gainesville, FL 32610-0286, USA.
authors.forename: Lyle L
authors.initials: LL
authors.lastname: Moldawer
authors.affiliation: Department of Surgery, Sepsis and Critical Illness Research Center, University of Florida College of Medicine, 1600 Southwest Archer Road, Room 6116, PO Box 100286, Gainesville, FL 32610-0286, USA. Electronic address: Frederick.Moore@surgery.ufl.edu.
authors.forename: Frederick A
authors.initials: FA
authors.lastname: Moore
mesh_terms: D016638:Critical Illness / Q000628:therapy; D006801:Humans; D007108:Immune Tolerance / Q000502:physiology; D007249:Inflammation / Q000150:complications* / Q000503:physiopathology; D008660:Metabolism / Q000502:physiology; D009102:Multiple Organ Failure / Q000628:therapy; D013577:Syndrome
keywords: Cachexia; Chronic critical illness; Multiple organ failure; Myeloid-derived suppressor cells; PICS; Sepsis; Shock; Trauma