%0 Journal Article
%T Innate Immune Function and Organ Failure Recovery in Adults With Sepsis
%A Aline B. Maddux
%A Ivor S. Douglas
%A Katherine H. Overdier
%A Laura L. Pyle
%A Terra D. Hiller
%J Journal of Intensive Care Medicine
%@ 1525-1489
%D 2019
%R 10.1177/0885066617701903
%X Sepsis stimulates pro- and anti-inflammatory immune responses. The innate immune response is critical to organ injury repair. We tested for an association between innate immune function and organ function recovery in a prospective cohort of immune-competent adults with sepsis. We conducted a prospective observational cohort study enrolling immune-competent adults with sepsis. We tested innate immune function by quantification of lipopolysaccharide (LPS)-stimulated tumor necrosis factor (TNF) ¦Á production capacity in whole blood samples on hospital days 1, 4, and 6. The primary outcome was organ function recovery on day 4 defined as a 4-point decrease in the composite cardiovascular and respiratory Sequential Organ Failure Assessment (SOFA) score components or a SOFA score ¡Ü2. Patients with sepsis who recovered organ function by day 4 (n = 11) had similar baseline characteristics when compared to those with ongoing organ failure (n = 13). Tumor necrosis factor ¦Á production capacity was similar between the 2 groups on hospital days 1 and 4 but significantly different on day 6. Patients who regained organ function recovery had significantly higher TNF-¦Á production capacity on day 6 (P = .01), which persisted after adjustment for age, Acute Physiology and Chronic Health Evaluation III score, and steroid administration (P = .03). There was no difference in TNF-¦Á production capacity over time in those who survived to hospital discharge versus nonsurvivors. Increasing TNF-¦Á production capacity is associated with improved organ failure recovery. Further studies are needed to evaluate a causal association between innate immune suppression and organ failure recovery as well as predictive accuracy for hospital survival. Impaired TNF-¦Á production as a marker of sepsis-associated innate immune dysfunction may be a feasible target for immune stimulation to decrease time to organ failure recovery
%K immune tolerance
%K multiple organ failure
%K innate immunity
%K critical care
%K endotoxin tolerance
%U https://journals.sagepub.com/doi/full/10.1177/0885066617701903