Persistent Inflammation, Immunosuppression and Catabolism Syndrome (PICS) after Polytrauma: A Rare Syndrome with Major Consequences

Nowadays, more trauma patients develop chronic critical illness (CCI), a state characterized by prolonged intensive care. Some of these CCI patients have disproportional difficulties to recover and suffer from recurrent infections, a syndrome described as the persistent inflammation, immunosuppressi...

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Bibliographic Details
Published in:Journal of clinical medicine 2020-01, Vol.9 (1), p.191
Main Authors: Hesselink, Lillian, Hoepelman, Ruben J, Spijkerman, Roy, de Groot, Mark C H, van Wessem, Karlijn J P, Koenderman, Leo, Leenen, Luke P H, Hietbrink, Falco
Format: Article
Language:English
Subjects:
Clinical medicine
Ethics
Hospitalization
Infections
Inflammation
Intensive care
Laboratories
Medical records
Mortality
Multiple organ dysfunction syndrome
Older people
Patients
Population
Sepsis
Spinal cord
Trauma
Traumatic brain injury
Ventilators
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Summary:Nowadays, more trauma patients develop chronic critical illness (CCI), a state characterized by prolonged intensive care. Some of these CCI patients have disproportional difficulties to recover and suffer from recurrent infections, a syndrome described as the persistent inflammation, immunosuppression and catabolism syndrome (PICS). A total of 78 trauma patients with an ICU stay of ≥14 days (CCI patients) between 2007 and 2017 were retrospectively included. Within this group, PICS patients were identified through two ways: (1) their clinical course (≥3 infectious complications) and (2) by laboratory markers suggested in the literature (C-reactive protein (CRP) and lymphocytes), both in combination with evidence of increased catabolism. The incidence of PICS was 4.7 per 1000 multitrauma patients. The sensitivity and specificity of the laboratory markers was 44% and 73%, respectively. PICS patients had a longer hospital stay (median 83 vs. 40, < 0.001) and required significantly more surgical interventions (median 13 vs. 3, = 0.003) than other CCI patients. Thirteen PICS patients developed sepsis (72%) and 12 (67%) were readmitted at least once due to an infection. In conclusion, patients who develop PICS experience recurrent infectious complications that lead to prolonged hospitalization, many surgical procedures and frequent readmissions. Therefore, PICS forms a substantial burden on the patient and the hospital, despite its low incidence.
ISSN:2077-0383
2077-0383
DOI:10.3390/jcm9010191