Platelet Immune Responses in Aging and Influenza and Sepsis (INVACS)

This will be a prospective observational cohort study comparing older (age≥65) and younger
(age<65) influenza and sepsis patients.

Inclusion Criteria:

- ≥18 years old at the time of enrollment

- Meet one of the following three main criteria:

A. INFLUENZA (AND OTHER RESPIRATORY VIRUS) PATIENTS:

Patients admitted to the intensive care unit (ICU) with a primary microbiologic diagnosis
of influenza (any strain) or other routinely clinically identified respiratory viruses
within 1 week of symptom onset. Influenza or other respiratory virus will be diagnosed
using an RT-PCR viral panel on a respiratory tract specimen, as is currently standard of
care on patients admitted to the ICUs at IMC with respiratory symptoms.

OR

B. SEPSIS PATIENTS:

Sepsis patients must have

1. Suspected or confirmed infection

AND

2. Organ dysfunction as defined by a SOFA >= 2 above baseline (if no baseline data
available, SOFA assumed to be 0)

OR

C. SEPTIC SHOCK PATIENTS:

AFTER INFUSION OF 20ML/KG CRYSTALLOID OR EQUIVALENT, Septic shock patients must have

1. Suspected or confirmed infection

AND

2. Lactate > 2 mmol/L

AND

3. Receiving vasopressors

- All patients must be enrolled into the study within 72 hours of ICU admission

Exclusion criteria

- Have a congenital or acquired immunodeficiency disorder (e.g., chronic variable immune
deficiency, agammaglobulinemia, hypogammaglobulinemia, leukocyte adhesion defects, IgA
deficiency, etc.)

- Have neutropenia (<1,000/mm3)

- Have received immunosuppressant medications within the previous 30 days (e.g.,
prednisone or prednisone equivalent at a dose≥10mg daily for ≥14 days or any
cyclosporine, TNF-alpha antagonists, tacrolimus, sirolimus, interferons,
mycophenolate, biological agents, methotrexate, azathioprine, polyclonal/monoclonal
antibodies, etc.)

- Have any history of bone marrow or organ transplantation

- Have an active malignancy (not including non-melanoma skin cancer or localized
prostate cancer), or have received chemotherapy drugs within the last 6 months.

- Have been admitted to the ICU for greater than 72 hours

- Have a Hemoglobin level <7gm/dl

- Have clinically significant bleeding