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Research Snapshot Theater: Pediatric VII

Rising Use of Immune Modulators in Pediatric Sepsis: Insights From an 8-Year PHIS Database Study

Monday, March 23, 2026
11:30 AM - 12:30 PM Central Time
Location: Connections Central - RST 07

  • Ananya Terala, B.A.

    Disclosure(s): No relevant financial relationship(s) to disclose.

  • TM

    Tatiana Mcanulty, B.A.

    Medical Student
    Case Western Reserve University School of Medicine

    Disclosure information not submitted.

  • Kenneth Remy, MD, MSc, MSCI, FCCM

    Case Western Reserve University/University Hospitals Cleveland Medical Center, Ohio

    Disclosure(s): No relevant financial relationship(s) to disclose.

  • SS

    Steven Shein, MD, FCCM

    Co-Director, Pediatric Critical Care Clinical, Basic & Translational Research Program
    Rainbow Babies and Childrens Hospital

    Disclosure information not submitted.

  • MM

    Monty Mazer, MD

    Assistant Professor of Pediatrics
    University Hospitals of Cleveland/Case Western

    Disclosure information not submitted.

Introduction: Sepsis-induced immune dysregulation is associated with poor outcomes, prompting interest in targeted immunotherapy. Several immunomodulatory agents are clinically available, but aligning specific drugs to individual sepsis phenotypes remains a challenge. We aim to characterize national practice patterns in the use of immunotherapies for pediatric sepsis using the Pediatric Health Information System (PHIS) database.


Methods: With IRB approval, we queried PHIS for sepsis (by APR-DRG codes) patients < 18 years admitted to a pediatric ICU between 2016–2024 including consults, diagnostics, and therapies (by billing codes). Patients with oncologic processes or incomplete data are excluded. Linear regression (change over time) and chi-square (binary variables) were used with p< 0.05 deemed significant.


Results: Among 42,308 subjects from 48 hospitals, 51% were male, aged 8.7+/-7.8 years. Mechanical ventilation (MV) was used in 43%, ECMO in 2.3%, and plasmapheresis in 0.75%. ICU LOS was a median of 4.0 days +/- IQR of 7.0 with a mortality rate of 5.7%. Use of checkpoint inhibitors (0.07% (2016-2019) to 0.2% (2020-2024); p< 0.001), nonsteroidal anti-inflammatory therapies (5% to 7%; p< 0.01), and complement mediators (0.01% to 0.02%; p< 0.05) increased, and were associated with higher severity of illness (SOI; i.e. use of MV or ECMO) and mortality (p < 0.05). Systemic corticosteroid use rose from 34% to 39% (p < 0.001), associated with both higher SOI and lower mortality (p<-0.001). Use of immune stimulants (IVIG, GM-CSF) remained stable (p>0.1) but transiently increased during the COVID-19 era (7% in general; 11% in 2020-2021). Testing of inflammatory markers and ferritin increased (p < 0.001), while immune labs (antibodies, mitogen testing) decreased (p < 0.001). Immunology (p < 0.01) and hematology (p < 0.001) consults increased.


Conclusions: Use of immunomodulatory agents in pediatric sepsis increased over the past decade, particularly in patients with greater SOI. Systemic corticosteroids are uniquely associated with survival. Concurrent increases in inflammatory testing and subspecialty consultations suggest growing interest in targeted immune modulation. These findings underscore the need for prospective studies to evaluate the efficacy and safety of immunotherapies in pediatric sepsis.