effect of interferon gamma as a treatment for post-aggressive immunosuppression in intensive care units, a randomized bayesian double-blind controlled trial versus placebo

Conditions: Post-aggressive Immunosuppression; Adult Patients Admitted to Intensive Care with Initial Severity (SOFA of the First 24 Hours Post-admission ≥ 6; Adult Under Mechanical Ventilation, and Presenting an MHLA-DR Less Than 8,000AB/C

Summary: the vast majority of serious clinical situations leading to intensive care (septic shock, polytrauma, acute cerebral aggression, major surgery) are characterized by significant systemic inflammation. recently, the existence of a common immune response pattern to acute aggression has been demonstrated, and with it the existence of a phenomenon known as post-aggressive immunosuppression (pais).

the vast majority of serious clinical situations leading to intensive care (septic shock, polytrauma, acute cerebral aggression, major surgery) are characterized by significant systemic inflammation. recently, the existence of a common immune response pattern to acute aggression has been demonstrated, and with it the existence of a phenomenon known as post-aggressive immunosuppression (pais). this immunological adaptation, initially implemented as a host defense mechanism to protect against an overwhelming systemic reaction, can, if prolonged, lead to multiple complications resulting in significant delayed morbidity and mortality. diagnosis is based on the use of immuno-inflammatory biomarkers, the most widely studied of which is monocyte expression of major histocompatibility complex type ii molecules (mhla-dr). we have recently confirmed that pais can affect all types of patients admitted to the intensive care unit, but mainly occurs in the most severe patients. we also showed that the occurrence of pais was strongly associated with the subsequent occurrence of secondary infection and excess mortality. currently, there is no treatment with proven efficacy for pais, but several drugs have been shown to restore leukocyte function in-vitro. several teams have reported the use of immunostimulatory molecules in patients with treatment failure, with a good safety profile and encouraging results. we believe that earlier treatment of patients with proven pais could improve their clinical outcome.

Eligibility criteria:
inclusion criteria: * patient ≥ 18 years old * sofa score for first 24 hours post-admission ≥ 6 * mechanically ventilated at the time of inclusion (non-invasive ventilation (niv) and high-flow nasal oxygen excluded) * mhla-dr\< 8,000 ab/c measured between the 5th and 10th day after admission to the intensive care unit * patient affiliated to a social security scheme * written consent (relative/trusted person) exclusion criteria: * patient with estimated life expectancy of less than 3 months * patients with a predicted remaining stay in intensive care \< 72 hours * patient with pre-existing immunosuppression: solid cancer active or in remission for \< 5 years, active hemopathy or in remission for \< 5 years, systemic disease (including in the absence of specific treatment), solid organ transplant or marrow allograft patient, patient suffering from a hiv infection * patients with an expected prolonged duration of mechanical ventilation: comatose or vegetative patients (admission for severe stroke with glasgow score \< 8, patient resuscitated from an arterial stroke,) patients with tracheotomy for ent problems, patients suffering from muscular disease (e.g. myopathy), patients on long-term mechanical ventilation * pregnant or breast-feeding women * contraindication of imukin (hypersensitivity to interferon gamma-1b or known hypersensitivity to related products, such as another interferon) * patients on immunosuppressive therapy, including long-term corticosteroid therapy (\>2.5mg/d prednisone equivalent) * patients with severe hepatic or renal insufficiency * patient included in another interventional clinical trial * people under court protection and protected adults

Keywords: critical care icu-acquired immune suppression hla-dr immunity sepsis