Identification of distinct immune subtypes in sepsis through dual immunomarker trajectory
Authors' conclusion
This study presents a practical immunological classification for sepsis based on the longitudinal dynamics of two immune markers.
Study context
- Population
- Adult septic patients with at least 3 measurements of C-reactive protein (CRP) and absolute lymphocyte count within 4 days after ICU admission
- Participants
- 3,223 patients · 3 cohorts
- Exposure
- Immune subgroups derived from CRP and absolute lymphocyte count (ALC) trajectories
- Immune homeostasisn = 39
- Immunosuppressionn = 180
- Immune imbalancen = 252
- Outcome
- Immune subgroups identified by trajectories of CRP and ALC
- Follow-up
- 4 days following ICU admission
Methodological detailsgroup-based multi-trajectory modeling, derivation, internal and external validation cohorts
- Group-based multi-trajectory modeling
- Derivation, internal and external validation cohorts
Main finding
As reported in the abstract
Subgroup distribution (derivation cohort, n = 471)
Observational data: associations, not effects.
Further findings
Clinical profiles, PICS and mortality
- Immune homeostasis: mildest severity, lowest PICS and mortality
- Immunosuppression: more chronic comorbidities, longer hospital stays, higher mortality
- Immune imbalance: most critical condition, more complications, longer ICU stays, highest PICS and mortality
Immune features (28 immune markers)
- Immune homeostasis: inflammatory resolution and near-normal immunity
- Immunosuppression: general reduction in lymphocyte subsets, persistent early T-cell activation, highest T cell inhibition
- Immune imbalance: cytokine storm, most severely impaired innate and adaptive immunity (markedly low monocyte human leukocyte antigen-DR (mHLA-DR), deficient late T cell activation)
Original publication
Identification of distinct immune subtypes in sepsis through dual immunomarker trajectory. Ann Intensive Care. Published 20 February 2026. doi:10.
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