Discussion
T-cell lymphopenia, inflammation, sCAP, lymphopenia, infection, neutrophilia, sepsis
PCT, INFLAMMATION, LYMPHOPENIA, INFECTION, NEUTROPHILIA, SEPSIS, INFLAMMATORY RESPONSE
Patients with sCAP enrolled into the phase II CIGMA trial generally had low baseline levels of IgM and IgG, a finding observed previously in patients with sCAP and sepsis [Large variations in the levels of inflammatory markers observed over time in the placebo-treated patients are also consistent with the occurrence of alternating hyper- and hypo-inflammatory states previously reported during severe infection [Trimodulin thus seems to be able to normalize immune dysregulation and reduce inflammation more rapidly in this patient population. This is also reflected in the mortality rates observed in the trimodulin- and placebo-treated groups where numerical differences were greater in those patients with more extreme immune/inflammatory values, i.e., ALCB- and T-cell lymphopenia are reported frequently in sCAP and sepsis patients [In addition to lymphopenia, neutrophilia is also frequently seen in sCAP patients. Chemo-attractants secreted by damaged and inflamed tissue and locally activated immune cells culminate in cytokine release that further fuels the inflammatory response [Changes in the NLR demonstrate the net impact of trimodulin treatment on ALC and ANC that were more rapidly normalized (Fig. In addition to the effects of trimodulin on the investigated cellular markers, the reduction in inflammation was also apparent through the enhanced and steady normalization of CRP and PCT levels (Fig. In the phase II CIGMA trial, the largest mortality differences with trimodulin treatment compared with placebo were seen in the subgroup of patients with IgM