Sepsis and septic shock.

Abstract

For more than two decades, sepsis was defined as a microbial infection that produces fever (or hypothermia), tachycardia, tachypnoea and blood leukocyte changes. Sepsis is now increasingly being considered a dysregulated systemic inflammatory and immune response to microbial invasion that produces organ injury for which mortality rates are declining to 15-25%. Septic shock remains defined as sepsis with hyperlactataemia and concurrent hypotension requiring vasopressor therapy, with in-hospital mortality rates approaching 30-50%. With earlier recognition and more compliance to best practices, sepsis has become less of an immediate life-threatening disorder and more of a long-term chronic critical illness, often associated with prolonged inflammation, immune suppression, organ injury and lean tissue wasting. Furthermore, patients who survive sepsis have continuing risk of mortality after discharge, as well as long-term cognitive and functional deficits. Earlier recognition and improved implementation of best practices have reduced in-hospital mortality, but results from the use of immunomodulatory agents to date have been disappointing. Similarly, no biomarker can definitely diagnose sepsis or predict its clinical outcome. Because of its complexity, improvements in sepsis outcomes are likely to continue to be slow and incremental.

• Authors: Richard S Hotchkiss, Lyle L Moldawer, Steven M Opal, Konrad Reinhart, Isaiah R Turnbull, Jean-Louis Vincent
• Journal: Nature reviews. Disease primers (Nat Rev Dis Primers) Vol. 2 Pg. 16045 (Jun 30 2016) ISSN: 2056-676X [Electronic] England
• PMID: 28117397 (Publication Type: Journal Article, Review)

Chemical References

• Anti-Bacterial Agents
• Biomarkers
• CCL2 protein, human
• CXCL10 protein, human
• Chemokine CCL2
• Chemokine CXCL10
• IL10 protein, human
• IL6 protein, human
• Interleukin-6
• Receptor, Anaphylatoxin C5a
• Interleukin-10

Topics

• Anti-Bacterial Agents (pharmacology, therapeutic use)
• Biomarkers (analysis, blood)
• Blood Coagulation Disorders (etiology, mortality)
• Chemokine CCL2 (analysis, blood)
• Chemokine CXCL10 (analysis, blood)
• Fever (etiology)
• Hemodynamics (physiology)
• Humans
• Hypothermia (etiology)
• Infection Control (methods)
• Interleukin-10 (analysis, blood)
• Interleukin-6 (analysis, blood)
• Multiple Organ Failure (etiology)
• Organ Dysfunction Scores
• Receptor, Anaphylatoxin C5a (analysis, antagonists & inhibitors, blood)
• Sepsis (diagnosis, epidemiology, physiopathology)
• Shock, Septic (diagnosis, epidemiology, physiopathology)
• Systemic Inflammatory Response Syndrome (complications)
• Tachycardia (etiology)
• Tachypnea (etiology)