PERSONALIZED ALGORITHM FOR IMMUNOCORRECTION IN PATIENTS WITH GENERALIZED PERITONITIS AND HIGH IMMUNOLOGICAL RISK

Аннотация

Background. Generalized peritonitis is associated with a high rate of adverse outcomes; empirical immunocorrection without risk stratification limits clinical effectiveness. A reproducible algorithm is needed to link the clinical–immunological profile to the intensity of immunomodulation. Aim. To clinically substantiate a personalized immunocorrection algorithm for patients with generalized peritonitis at high or critical immunological risk. Materials and Methods. Single-center prospective study (n = 60). On postoperative day 1, immunological stratification (CD4⁺, NK, IgM, circulating immune complexes [CIC], IL-6/IL-10) assigned patients to low, high, or critical risk; the present analysis focused on the high- and critical-risk groups. The algorithm specified basic or extended immunocorrection with checkpoints on days 3 and 7, allowing escalation/de-escalation. Statistical analysis used non-parametric tests and descriptive analytics. Results. Stratification yielded: low — 18 (30.0%), high — 26 (43.3%), critical — 16 (26.7%). Therapeutic routing was guided by clinical–immunological indicators and aligned with the initial clinical phase: in the critical-risk group, the terminal phase predominated and the reactive phase was absent; in the high-risk group, the toxic phase predominated. The algorithm proved operationally manageable owing to predefined checkpoints and escalation criteria. Conclusion. The personalized algorithm enables standardized, profile-driven decision-making on immunocorrection and improves treatment controllability. Before integration into clinical protocols, multicenter validation, harmonization of escalation/de-escalation thresholds, and formalization of risk-category calculation rules are required.