Long-term immunosuppressive treatment is not associated with worse outcome in patients hospitalized in the intensive care unit for septic shock: the PACIFIC study

• Published in: Critical care (London, England) England), 2023-09, Vol.27 (1), p.1-340, Article 340
• Main Authors: Vaidie, Julien, Peju, Edwige, Jandeaux, Louise-Marie, Lesouhaitier, Mathieu, Lacherade, Jean-Claude, Guillon, Antoine, Wittebole, Xavier, Asfar, Pierre, Evrard, Bruno, Daix, Thomas, Vignon, Philippe, François, Bruno
• Format: Article
• Language: English
• Subjects: Autoimmune diseases; Care and treatment; Chemotherapy; Complications and side effects; Critical care; Diagnosis; Hemodialysis; Hospital patients; Hospitalization; Immunosuppression; Immunosuppression therapy; Intensive care; Intensive care unit; Monoclonal antibodies; Mortality; Multivariate analysis; Organ transplantation; Patient outcomes; Risk factors; Sepsis; Septic shock; Systemic diseases; TNF inhibitors; Transplantation of organs, tissues, etc; Transplants & implants; Ventilators
• ISSN: 1364-8535; 1364-8535; 1366-609X; 1466-609X
• DOI: 10.1186/s13054-023-04626-z

Background Except in a few retrospective studies mainly including patients under chemotherapy, information regarding the impact of immunosuppressive therapy on the prognosis of patients admitted to the intensive care unit (ICU) for septic shock is scarce. Accordingly, the PACIFIC study aimed to asses if immunosuppressive therapy is associated with an increased mortality in patients admitted to the ICU for septic shock. Methods This was a retrospective epidemiological multicentre study. Eight high enroller centres in septic shock randomised controlled trials (RCTs) participated in the study. Patients in the "exposed" group were selected from the screen failure logs of seven recent RCTs and excluded because of immunosuppressive treatment. The "non-exposed" patients were those included in the placebo arm of the same RCTs. A multivariate logistic regression model was used to estimate the risk of death. Results Among the 433 patients enrolled, 103 were included in the "exposed" group and 330 in the "non-exposed" group. Reason for immunosuppressive therapy included organ transplantation (n = 45 [44%]) or systemic disease (n = 58 [56%]). ICU mortality rate was 24% in the "exposed" group and 25% in the "non-exposed" group (p = 0.9). Neither in univariate nor in multivariate analysis immunosuppressive therapy was associated with a higher ICU mortality (OR: 0.95; [95% CI 0.56-1.58]: p = 0.86 and 1.13 [95% CI 0.61-2.05]: p = 0.69, respectively) or 3-month mortality (OR: 1.13; [95% CI 0.69-1.82]: p = 0.62 and OR: 1.36 [95% CI 0.78-2.37]: p = 0.28, respectively). Conclusions In this study, long-term immunosuppressive therapy excluding chemotherapy was not associated with significantly higher or lower ICU and 3-month mortality in patients admitted to the ICU for septic shock. Keywords: Septic shock, Intensive care unit, Immunosuppression therapy, Organ transplantation, Autoimmune diseases, Mortality