Title : Addressing the care pathway in post-sepsis patients: Immunometabolic challenges, clinical follow-up, and public health strategies
Abstract:
Patients who survive sepsis face a significantly increased risk of developing a complex constellation of long-term complications, collectively referred to as post-sepsis syndrome (PSS). This condition is characterized by persistent immunological dysfunction, metabolic alterations, and a spectrum of physical, cognitive, and psychological impairments. Epidemiological data indicate that approximately 60% of sepsis survivors are rehospitalized within the first six months, with a substantial proportion of these readmissions deemed preventable. Furthermore, up to 30% exhibit sustained immune dysregulation. At the immunometabolic level, there is evidence of lasting reprogramming in myeloid cells, including disrupted mitochondrial signaling, increased endotoxin tolerance, and impaired cytokine production, all of which contribute to a state of functional immunosuppression. This compromised immune profile diminishes host defense mechanisms, increases susceptibility to secondary infections, and facilitates the reactivation of latent pathogens. Metabolically, persistent shifts in oxidative phosphorylation and the accumulation of metabolites such as succinate and lactate sustain a low-grade inflammatory state. Clinically, survivors often experience chronic fatigue, progressive functional decline, and mood disorders, including anxiety and depression, which hinder recovery and reintegration. Post-sepsis care pathways remain largely uncoordinated, and few structured models exist for comprehensive follow-up. National cohorts in France and Germany have shown that implementing specialized post-sepsis clinics can enable early identification of sequelae and reduce adverse outcomes. From a public health perspective, early risk stratification, integration of multidisciplinary care teams, and enhanced education in primary care are essential strategies to improve outcomes and prevent the chronicity of post-sepsis damage. Systematic clinical follow-up, targeted immunometabolic interventions, and tailored healthcare policies represent an emerging priority in modern medicine for this growing population of vulnerable patients.
