{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,4]],"date-time":"2026-07-04T15:31:29Z","timestamp":1783179089922,"version":"3.54.6"},"reference-count":42,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2022,11,14]],"date-time":"2022-11-14T00:00:00Z","timestamp":1668384000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Immunology"],"published-print":{"date-parts":[[2023,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Immunoparalysis is associated with poorer outcomes in the paediatric intensive care unit (PICU) setting. We aimed to determine the group of patients with higher chances of immunoparalysis and correlate this status with increased risks of nosocomial infection and adverse clinical parameters. We conducted an exploratory study with prospective data collection in a university\u2010affiliated tertiary medical, surgical, and cardiac PICU. Fifteen patients with multiple organ dysfunction syndrome were included over a period of 6 months. Monocyte's human leucocyte antigen (HLA)\u2010DR expression and tumour necrosis factor (TNF)\u2010\u03b1 and interleukin (IL)\u20106 production were measured by flow\u2010cytometry at three time points (T1\u00a0=\u00a01\u20132\u2009days; T2\u00a0=\u00a03\u20135\u2009days; T3\u00a0=\u00a06\u20138\u2009days). Using the paediatric logistic organ dysfunction\u20102 score to assess initial disease severity, we established the optimal cut\u2010off values of the evaluated parameters to identify the subset of patients with a higher probability of immunoparalysis. A comparative analysis was performed between them. Sixty per cent were males; the median age was 4.1\u2009years. Considering the presence of two criteria in T1 (classical monocytes mean fluorescence intensity [MFI] for HLA\u2010DR\u2009\u2264\u20091758.5, area under the curve (AUC)\u00a0=\u00a00.775; and frequency of monocytes producing IL\u20106\u2009\u2264\u200968.5%, AUC\u00a0=\u00a00.905) or in T3 (classical monocytes MFI of HLA\u2010DR\u2009\u2264\u20092587.5, AUC\u00a0=\u00a00.675; and frequency of monocytes producing TNF\u2010\u03b1\u2009\u2264\u200993.5%, AUC\u00a0=\u00a00.833), a variable to define immunoparalysis was obtained (100% sensitivity, 81.5% specificity). Forty per cent of patients were assigned to the immunoparalysis group. In this: a higher frequency of nosocomial infection (<jats:italic>p<\/jats:italic>\u00a0=\u20090.011), vasoactive inotropic score (<jats:italic>p<\/jats:italic>\u00a0=\u20090.014) and length of hospital stay (<jats:italic>p<\/jats:italic>\u00a0=\u20090.036) was observed. In the subgroup with the diagnosis of sepsis\/septic shock (<jats:italic>n<\/jats:italic>\u00a0=\u20095), patients showed higher percentages of non\u2010classical monocytes (<jats:italic>p<\/jats:italic>\u00a0=\u20090.004). No mortality was recorded. A reduction in classical monocytes HLA\u2010DR expression with lower frequencies of monocytes producing TNF\u2010\u03b1 and IL\u20106 during the first week of critical illness, appears to be a good marker of immunoparalysis; these findings relate to an increased risk of nosocomial infection and deleterious outcomes. The increased frequency of non\u2010classical monocytes in patients with sepsis\/septic shock is suggestive of a better prognosis.<\/jats:p>","DOI":"10.1111\/imm.13595","type":"journal-article","created":{"date-parts":[[2022,10,24]],"date-time":"2022-10-24T16:54:52Z","timestamp":1666630492000},"page":"597-609","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Immunoparalysis in critically ill children"],"prefix":"10.1111","volume":"168","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8604-5565","authenticated-orcid":false,"given":"Filipa Loureiro","family":"Neves","sequence":"first","affiliation":[{"name":"Pediatric Intensive Care Unit Hospital Pedi\u00e1trico, Centro Hospitalar e Universit\u00e1rio de Coimbra  Coimbra Portugal"},{"name":"Children and Women Department Centro Hospitalar do M\u00e9dio Tejo  Torres Novas Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariana Nunes Gon\u00e7alves Afonso","family":"Amaral","sequence":"additional","affiliation":[{"name":"Pediatric Intensive Care Unit Hospital Pedi\u00e1trico, Centro Hospitalar e Universit\u00e1rio de Coimbra  Coimbra Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandra Filomena Dur\u00e3es","family":"da Silva","sequence":"additional","affiliation":[{"name":"Flow Cytometry Unit, Department of Clinical Pathology Centro Hospitalar e Universit\u00e1rio de Coimbra (CHUC)  Coimbra Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabel Maria Melo","family":"Silva","sequence":"additional","affiliation":[{"name":"Flow Cytometry Unit, Department of Clinical Pathology Centro Hospitalar e Universit\u00e1rio de Coimbra (CHUC)  Coimbra Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paula Margarida dos Santos","family":"Laranjeira","sequence":"additional","affiliation":[{"name":"Flow Cytometry Unit, Department of Clinical Pathology Centro Hospitalar e Universit\u00e1rio de Coimbra (CHUC)  Coimbra Portugal"},{"name":"Coimbra Institute for Clinical and Biomedical Research (iCBR) Faculty of Medicine, University of Coimbra  Coimbra Portugal"},{"name":"Center for Innovative Biomedicine and Biotechnology (CIBB) University of Coimbra  Coimbra Portugal"},{"name":"Center for Neuroscience and Cell Biology (CNC) University of Coimbra  Coimbra Portugal"},{"name":"Coimbra Institute for Clinical and Biomedical Research (iCBR) \u2013 Group of Environment Genetics and Oncobiology (CIMAGO) \u2013 Faculty of Medicine, University of Coimbra  Coimbra Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carla Regina de Jesus","family":"Pinto","sequence":"additional","affiliation":[{"name":"Pediatric Intensive Care Unit Hospital Pedi\u00e1trico, Centro Hospitalar e Universit\u00e1rio de Coimbra  Coimbra Portugal"},{"name":"University Clinic of Pediatrics, Faculty of Medicine University of Coimbra  Coimbra Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Artur Augusto","family":"Paiva","sequence":"additional","affiliation":[{"name":"Flow Cytometry Unit, Department of Clinical Pathology Centro Hospitalar e Universit\u00e1rio de Coimbra (CHUC)  Coimbra Portugal"},{"name":"Coimbra Institute for Clinical and Biomedical Research (iCBR) Faculty of Medicine, University of Coimbra  Coimbra Portugal"},{"name":"Center for Innovative Biomedicine and Biotechnology (CIBB) University of Coimbra  Coimbra Portugal"},{"name":"Coimbra Institute for Clinical and Biomedical Research (iCBR) \u2013 Group of Environment Genetics and Oncobiology (CIMAGO) \u2013 Faculty of Medicine, University of Coimbra  Coimbra Portugal"},{"name":"Instituto Polit\u00e9cnico de Coimbra, ESTESC\u2010Coimbra Health School Ci\u00eancias Biom\u00e9dicas Laboratoriais  Coimbra Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea Sofia da Silva","family":"Dias","sequence":"additional","affiliation":[{"name":"Pediatric Intensive Care Unit Hospital Pedi\u00e1trico, Centro Hospitalar e Universit\u00e1rio de Coimbra  Coimbra Portugal"},{"name":"University Clinic of Pediatrics, Faculty of Medicine University of Coimbra  Coimbra Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Leonor Almeida Carvalho Vieira","family":"Coelho","sequence":"additional","affiliation":[{"name":"Pediatric Intensive Care Unit Hospital Pedi\u00e1trico, Centro Hospitalar e Universit\u00e1rio de Coimbra  Coimbra 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