Enhanced insights into immunity traits of elderly patients in the intensive care unit with infections: evidence from a multicenter, prospective observational study

Zou, J; Xiao, Y; Zhang, L; Zuo, Z; Wang, X; Liao, X; Cui, N; Jin, J; Qian, Z; Wu, A; Li, C

doi:10.1186/s13054-025-05616-z

Sepsis & infection

Enhanced insights into immunity traits of elderly patients in the intensive care unit with infections: evidence from a multicenter, prospective observational study

Crit CarePublished 28 Aug 2025Prospective observational study

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Authors' conclusion

Elderly patients in the ICU, especially those with sepsis, exhibit immune imbalances of hyperinflammation and immunosuppression, varying with age, sex, pathogen type, and infection site.

Study context

Population: Elderly patients (≥ 60 years) with infections admitted to the intensive care units (ICUs) of four hospitals, May 2023–October 2024
Participants: 1,152 patients · 4 hospitals

Exposure: Sepsis vs non-sepsis infection
Sepsisn = 640
Outcome: Immune–mortality associations (fully adjusted model)

Methodological detailsmulticentre

Multicentre

Main finding

As reported in the abstract

Non-sepsis infection: reduced monocytes, lymphocytes and TNFα (OR < 1), elevated IL12 and INFγ (OR > 1), all P < 0.05
Sepsis: increased neutrophil and B-cell activation (OR > 1), decreased T cells (OR < 1), all P < 0.05; no specific cytokine signature (all P > 0.05)
Fully adjusted model

Observational data: associations, not effects.

Further findings

Mortality

P < 0.001

Sepsis9.51%

Non-sepsis infection0.98%

Mechanical ventilation

P < 0.001

Sepsis40.80%

Non-sepsis infection3.12%

Hospitalization

P < 0.001

Sepsis11.8 daysinterval 6.00–18.0

Non-sepsis infection7.00 daysinterval 4.00–10.0

Age > 80 years (subgroup)

Marked lymphopenia, lower CD4+ T cell counts (β < 1, P < 0.05), elevated IL6 and platelets (β > 1, P < 0.05)

Pathogen type (subgroup)

Fungal vs bacterial: increased lymphocyte and cytotoxic T lymphocyte counts (β > 1, P < 0.05)
Viral: reduced T cell subsets and cytokines (IL6, IL8, IL17; β < 1, P < 0.05)

Sex and age (subgroup)

Higher innate immune markers in males, higher adaptive immune indicators in females
With age, reduced T cell counts and increased procalcitonin and C-reactive protein

Original publication

Enhanced insights into immunity traits of elderly patients in the intensive care unit with infections: evidence from a multicenter, prospective observational study. Crit Care. Published 28 August 2025. doi:10.1186/s13054-025-05616-z

Read the original article ↗

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