摘要 : In this issue of the Journal, van Vught and colleagues (pp. 458-470) report that hyperinflammation, apart from the previously reported immune suppression, contributes to the susceptibility to develop secondary infections in patien... 展开 In this issue of the Journal, van Vught and colleagues (pp. 458-470) report that hyperinflammation, apart from the previously reported immune suppression, contributes to the susceptibility to develop secondary infections in patients with sepsis admitted to the intensive care unit (ICU) (1). In this large cohort (>1,000 patients), the patients who developed secondary infections had higher disease severity scores and were more likely to suffer from septic shock on ICU admission. As a more dysregulated host response to the primary infection is likely related to disease severity, this is not surprising, but it may increase the chances of residual confounding. However, the authors nicely show that the differences between groups remain statistically significant after propensity score matching for Acute Physiology and Chronic Health Evaluation-IV score, Sequential Organ Failure Assessment score, source of infection, and presence of shock, as well as additional sensitivity analyses related to immune-suppressive underlying diseases and treatment. As more pronounced hyperinflammation persisted to relate to the development of secondary infections, even when controlled for clinical variables related to disease severity and immunity, this observation indicates that development of a secondary infection is intrinsically related to the more dysregulated host response and is not merely the result of an epiphenomenon. 收起