What question did this study set out to answer?

This research aims to identify serum biomarkers that predict chronic critical illness and long-term outcomes in patients with abdominal sepsis.

March 28, 2026

Dynamic Profiling of Angiogenic, Metabolic, and Immune Checkpoint Biomarkers Predicts Chronic Critical Illness and Long-term Outcomes in Abdominal Sepsis

Key Points

This research aims to identify serum biomarkers that predict chronic critical illness and long-term outcomes in patients with abdominal sepsis.
Conducted a prospective longitudinal study in a tertiary acute care center
Measured serum levels of 13 biomarkers at days 1, 4, 7, and 14 after diagnosis
Categorized patients into Rapid Recovery and Chronic Critical Illness groups
Developed predictive models using the PIRO framework combined with biomarker trends
Patients with Chronic Critical Illness had poorer outcomes compared to those with Rapid Recovery
Dynamic profiling showed significant differences in biomarkers between groups
Elevated levels of immunosuppressive (e.g., sPD-L1, Arg-1) and inflammatory markers (e.g., IP-10) in CCI patients
Multivariate models predicted CCI by day 4 (AUC = 0.899) and one-year outcomes by day 7 (AUC = 0.851)

Abstract

Background: Many patients who survive abdominal sepsis develop Chronic Critical Illness (CCI), characterized by prolonged intensive care unit (ICU) stay, ongoing organ dysfunction, and poor one-year outcomes. Current severity scoring systems, such as SOFA and APACHE II, are not effective in identifying patients at high risk for this trajectory, limiting the opportunities for early intervention. Methods: We conducted a prospective longitudinal study of adults diagnosed with abdominal sepsis at a tertiary acute care center. The serum levels of 13 biomarkers were measured on days 1, 4, 7, and 14 after diagnosis. Patients were grouped into two categories: Rapid Recovery (RAP) and CCI. Predictive models were developed by combining clinical data based on the Predisposition, Insult, Response, and Organ dysfunction (PIRO) framework with biomarker trends to assess the evolving host response. Results: Patients with CCI showed poorer clinical outcomes than those with RAP. Among the 252 patients included in the analysis, dynamic profiling revealed significant differences between the RAP and CCI groups. Patients who developed CCI exhibited persistently elevated levels of immunosuppressive biomarkers (sPD-L1, Arg-1, and TGF-β) and inflammatory markers (IP-10), along with dysregulation of the angiogenic and metabolic pathways. Multivariate models incorporating PIRO variables showed strong performance in predicting CCI by day 4 (AUC = 0.899) and poor one-year outcomes (Zubrod 4/5) by day 7 (AUC = 0.851). The addition of key biomarkers significantly enhanced the predictive accuracy for both CCI (AUC = 0.926) and functional outcomes (AUC = 0.910). Conclusions: Our findings suggest that Persistent Inflammation, Immunosuppression, and Catabolism Syndrome (PICS), a maladaptive pathophysiological state, plays a central role in the development of CCI following abdominal sepsis. The combination of serial biomarker data and clinical variables enables earlier and more accurate risk stratification. This approach may support timely and targeted interventions to improve patient survival and long-term recovery.

Bookmark

Cite This Study

Xu et al. (Tue,) studied this question.

synapsesocial.com/papers/69c772158bbfbc51511e257f https://doi.org/https://doi.org/10.1097/shk.0000000000002829

Bookmark