PhD Scientific Days 2025

Pharmaceutical Sciences and Health Technologies III.

Role of Immunomodulatory Strategies to Improve Outcomes in Sepsis

Name of the presenter

Hollosi Julia

Institute/workplace of the presenter

Semmelweis University

Authors

Julia Hollosi¹

1: Semmelweis University

Text of the abstract

Introduction:
Sepsis remains a leading cause of mortality in intensive care units (ICUs), affecting approximately one-third of ICU patients globally, with a fatality rate nearing 30%. In sepsis, there is a dysregulated host immune response to bacterial endotoxins, which leads to a cytokine storm and immunoglobulin deficiency due to increased consumption and decreased production of immunoglobulins. As a result, immunomodulatory therapies such as intravenous immunoglobulin (IVIG), plasmapheresis, hemadsorption, and polymyxin B adsorption have been proposed as adjunctive treatments to standard care.

Aims:
We aimed to determine whether immunomodulatory therapies such as IVIG, plasmapheresis, hemadsorption, and polymyxin B adsorption have a beneficial effect on organ dysfunction and mortality in septic patients.

Method:
We conducted a network meta analysis and systematic review regarding immunomodulatory therapies for septic patients. A systematic search was performed in three major databases: PubMed, EMBASE, and Cochrane. Studies included randomized controlled trials (RCTs) of adult septic populations; pediatric and animal studies, and all observational trials, were excluded. Outcomes assessed were changes in organ dysfunction scores and 28-day mortality. Risk of bias was evaluated using the CINeMA tool, and results were visualized via forest and surface under the cumulative ranking curve (SUCRA) plots.

Results:
Out of 3778 identified articles, 78 RCTs met inclusion criteria. Results showed that IVIG demonstrated a strong trend toward reducing organ dysfunction and mortality. Other therapies also showed potential benefits in improving both organ function and survival compared to standard care.

Conclusion:
Our findings suggest possible advantages of adjunctive immunomodulatory therapies in sepsis management. However, heterogeneity in outcome reporting and dosing regimens introduces statistical imprecision. Therefore, although more trials are required to determine the best timing-dosage strategy, doctors should consider adding adjunctive immunomodulatory therapies to standard therapies for septic patients.

Funding:
There was no funding for this study.
Prospero registration number: CRD42024602344

julia@hollosi.com
Semmelweis University, Centre of Translational Medicine
Dr. Zsolt Molnar, Dr. Laszlo Zubek, Dr. Caner Turan, Dr. David Laczko
Oral presentation