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ORIGINAL RESEARCH article

Front. Med.
Sec. Intensive Care Medicine and Anesthesiology
Volume 11 - 2024 | doi: 10.3389/fmed.2024.1465397

Development and validation of clinical criteria for critical illness-associated immune dysfunction (CIID)：based on the MIMIC-IV database

Provisionally accepted
Yanyou Zhou Yanyou Zhou 1,2Linfeng Tao Linfeng Tao 1,2Shengsheng Yang Shengsheng Yang 1,2Juntu Li Juntu Li 1,2Jun Liu Jun Liu 1,2*
  • 1 Nanjing Medical University, Nanjing, China
  • 2 Suzhou Municipal Party School, Suzhou, Liaoning Province, China

The final, formatted version of the article will be published soon.

    Critical illness-associated immune dysfunction (CIID) is prevalent in the ICU and frequently resulted in uncontrollably immune responses. Critical immunological dysfunction is understood to be important, although there are currently no clinically accepted diagnostic criteria for it. Given this, we examined the literature and developed an initial diagnostic criterion that we validated using the MIMIC-IV database. The analysis included 43,965 patients, with approximately 77% meeting the diagnostic criteria for CIID. Different criteria were used to categorize patients into groups related to immune dysfunction (ID) and non-immune dysfunction (NID).Within the ID group, patients were subdivided into three subgroups: hyperinflammatory (HI), immunosuppression (IS), and a subgroup combining immunosuppression and hyperinflammation (HI+IS). We observed that patients with immune dysfunction possessed higher APACHE II scores and there were differences in peak APACHE II among the three subgroups. When comparing patients' 30-day mortality in the COX model, it is evident that patients in the IS subgroup had the lowest risk and patients in the HI subgroup the greatest risk after accounting for all covariates. In contrast, patients in the IS subgroup had the highest risk of death, those in the HI subgroup had the lowest risk when comparing long-term mortality. In summary, we propose and validate diagnostic criteria related to CIID. Subgroup analyses were carried out, which also revealed variations between the three groups.The diagnostic criteria were confirmed by the MIMIC-IV database, demonstrating the diagnostic criteria were scientifically valid and reliable.

    Keywords: Immune responses, critical immunological dysfunction, hyperinflammatory, Immunosuppression, MIMIC-IV

    Received: 16 Jul 2024; Accepted: 20 Nov 2024.

    Copyright: © 2024 Zhou, Tao, Yang, Li and Liu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Jun Liu, Nanjing Medical University, Nanjing, China

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.