Fig. 1. Immunological response in sepsis across time.

Sepsis initiates a complex immune response with the concomitant occurrence of excessive systemic inflammation at an early stage and relative immunosuppression at the late stage. Some patients die in the early stage of the uncontrolled proinflammatory response, whereas some patients die during the late stage of irreversible immune suppression. Different markers are used to distinguish the immunological thresholds, including mHLA-DR expression in <30% of cells, LPS-induced TNF-α level <200 pg/mL in whole blood, and absolute lymphocyte counts <1000 cells/mm³. GM-CSF treatment is preferred for use in patients with severe immunosuppression. mHLA-DR monocytic human leukocyte antigen DR, LPS lipopolysaccharide.