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Critical Care Medicine www.ccmjournal.org e789 and T lymphocytes and dendritic cells. This depletion in immune effector cells in sepsis is manifested in many ways including loss of the delayed type hypersensitivity (DTH) response to recall antigens (5). It is likely that this loss in DTH would make autoimmune complications less common in patients with sepsis. In short, although we agree with Suresh and D’Alessio (1) about concern for possible adverse autoimmune side effects of checkpoint inhibitors in sepsis, we believe that the risk to benefit ratio lies in favor of using checkpoint inhibitors in patients who have a high risk of death. Checkpoint inhibitors have shown clinical efficacy in patients with viral infections, for example, hepatitis C and progressive multifocal leukoencephalopathy, and in life threatening fungal infections (6, 7). Given these positive results, as well as a large number of animal studies, we believe that checkpoint inhibitors have great promise in bacterial sepsis as well. Drs. Hotchkiss’s, Yende’s, Crouser’s, Martin’s, Brakenridge’s, and Park’s institutions received funding from Bristol Meyers Squibb. Dr. Hotchkiss received funding from Bristol Myers Squibb and GlaxoSmithKline; he received support for article research from the National Institutes of Health (NIH); and he disclosed off-label product use of a checkpoint inhibitor. Dr. Yende’s institution received funding from Roche, and he received funding from AtoxBio. Drs. Yende and Mayr disclosed government work. Dr. Angus received funding from Bristol Myers Squibb. Dr. Moldawer disclosed off-label product use of Nivolumab. Dr. Martin disclosed off-label product use of an investigational drug for sepsis. Dr. Park’s institution received funding from NIH/National Heart, Lung, and Blood Institute, U.S. Food and Drug Administration/Biomedical Advanced Research and Development Authority, AtoxBio, Marcus Foundation, and Society of Critical Care Medicine Council, and she disclosed off-label product use of antiprogrammed cell death ligand-1, BMS 936559. Dr. Coopersmith disclosed that he does not have any potential conflicts of interest.