Epstein-Barr virus (EBV) reactivation and immunoparalysis indicate a harmful immune endotype in sepsis
Authors' conclusion
Our preliminary findings suggest that EBV reactivation superimposed on immunoparalysis is associated with a harmful sepsis endotype combining excessive cytokine activity with impaired monocyte function.
Study context
- Population
- Intensive care unit (ICU) patients with sepsis
- Participants
- 124 patients
- Exposure
- EBV/immunoparalysis (IP) status groups
- Outcome
- Mortality
Methodological detailstime-dependent Cox models (start-stop structure), adjusted for age, sex and SOFA score
- Time-dependent Cox models (start-stop structure)
- Adjusted for age, sex and SOFA score
Main finding
As reported in the abstract
Hazard ratio (95% CI)P value
EBV positivity
3.30(1.24–8.81)
P = 0.0009IPnonsignificant trend
2.14(0.93–4.90)
P = 0.073EBV + IP+highest mortality
7.23(2.24–23.3)
P = 0.0009Observational data: associations, not effects.
Further findings
- EBV + IP+: strongest cytokine activation (IL-6, IL-8, IL-10, IL-17 A, IL-18, MCP-1) and lowest mHLA-DR expression, mixed hyperinflammatory and immunosuppressed phenotype
- EBV- IP-: most immunocompetent baseline profile
Original publication
EBV reactivation and immunoparalysis indicate a harmful immune endotype in sepsis. Crit Care. Published 7 May 2026. doi:10.
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