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Master Thesis

Caractéristiques et impact pronostique des différents types d'immunodépression chez les patients admis en réanimation pour sepsis sévère ou choc septique

Abstract : Introduction: current data on patients with pre-existing immunosuppression and severe infection are limited. This study aims to describe these patients when admitted to ICU for severe sepsis or septic shock, to compare them with immunocompetent and to evaluate the prognostic impact of the type of immunosuppression. Materials and Methods: we conducted an observational study using a prospective multicenter database. All patients admitted for severe sepsis or septic shock from January 1997 to August 2011 in 11 French ICUs were included. Immunocompromised patients were classified into six profiles of immunosuppression. Prognostic analysis used a competitive risk model (Fine and Gray), in which ICU or hospital discharge being alive before D28 competed with death. Results: 1981 patients were included among whom 607 (31%) were immunocompromised (27% solid cancer, 46% hematological malignancy, 11% AIDS, 9% solid organ transplantation, 13% inflammatory disease, 1% primary or congenital deficiency). The death rate at D28 is 31.3% in immunocompromised (vs. 28.8%). After adjustment on other prognostic factors, immunosuppression (all causes) is an independent risk factor for death at D28 (sHR 1.37 [1.12-1.67]). When we analyzed immunosuppression in classes, only AIDS (sHR = 1.9), solid cancer (sHR = 1.8) or hematology (sHR = 1.4) without agranulocytosis and agranulocytosis (sHR = 1.7) are independently associated with prognosis. Conclusion: immunosuppression is common in patients with severe sepsis or septic shock. Survival analysis shows that some profiles of immunosuppression, in addition to agranulocytosis already described, are associated with an increased risk of death.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-00858666
Contributor : Jean-Hugues Morneau <>
Submitted on : Thursday, September 5, 2013 - 4:56:22 PM
Last modification on : Tuesday, May 11, 2021 - 11:36:17 AM
Long-term archiving on: : Thursday, April 6, 2017 - 4:01:25 PM

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  • HAL Id : dumas-00858666, version 1

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Violaine Tolsma. Caractéristiques et impact pronostique des différents types d'immunodépression chez les patients admis en réanimation pour sepsis sévère ou choc septique. Médecine humaine et pathologie. 2013. ⟨dumas-00858666⟩

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