Immunological support technology as a basis for personalized management of patients with secondary immunodeficiency states

Background: The increasing intensity of modern immunosuppressive and biologic therapy protocols necessitates a revision of infection control strategies. Patients with secondary immunodeficiency states remain the most vulnerable group, requiring the development of personalized support technologies within a multidisciplinary hospital setting.

Aim: To develop and implement a program of immunological support for immunocompromised patients in a therapeutic clinic.

Methods: A retrospective analysis of the clinical profiles of patients with secondary immunodeficiency states was performed based on a database of 2,537 patients at the Sverdlovsk Regional Clinical Hospital No. 1 (2013–2018). The efficacy of the support technology was prospectively studied in patients with inflammatory bowel disease (n = 178) and insulin-requiring diabetes mellitus (n = 256). Immune status assessment included flow cytometry (lymphocyte subsets), turbidimetry (immunoglobulins), and phagocytosis evaluation (nitro blue tetrazolium test).

Results: In inflammatory bowel disease, phagocytic defects and deficiencies of lymphocyte populations/subpopulations were the most common abnormalities; an increase in lymphocyte killer activity correlated with disease exacerbation. Patients with diabetes mellitus exhibited persistent lymphopenia and suppression of phagocytic activity, correlating with poor glycemic control. The implementation of the immunological support technology, including early screening for impairments and preventive vaccination, led to a 3-fold reduction in the frequency of all infectious episodes in patients with IBD and DM. Furthermore, the incidence of severe infectious complications, such as pneumonia, decreased nearly 10-fold in the IBD group and 5-fold in patients with insulin-requiring DM (p ≤ 0.05) when the developed technology was applied.The metabolic neutrality and safety of vaccination were demonstrated: glycated hemoglobin levels and endoscopic findings remained stable post-vaccination.

Conclusion: Integrating immunological support technology into the management algorithms of medical patients transforms passive observation into active prevention, ensuring a significant reduction in the infectious burden and increasing the safety of high-tech medical treatment.