scholarly journals Inflammation-Induced Coagulopathy Substantially Differs Between COVID-19 and Septic Shock: A Prospective Observational Study

2022 ◽  
Vol 8 ◽  
Author(s):  
Mélanie Dechamps ◽  
Julien De Poortere ◽  
Manon Martin ◽  
Laurent Gatto ◽  
Aurélie Daumerie ◽  
...  

Critical COVID-19, like septic shock, is related to a dysregulated systemic inflammatory reaction and is associated with a high incidence of thrombosis and microthrombosis. Improving the understanding of the underlying pathophysiology of critical COVID-19 could help in finding new therapeutic targets already explored in the treatment of septic shock. The current study prospectively compared 48 patients with septic shock and 22 patients with critical COVID-19 regarding their clinical characteristics and outcomes, as well as key plasmatic soluble biomarkers of inflammation, coagulation, endothelial activation, platelet activation, and NETosis. Forty-eight patients with matched age, gender, and co-morbidities were used as controls. Critical COVID-19 patients exhibited less organ failure but a prolonged ICU length-of-stay due to a prolonged respiratory failure. Inflammatory reaction of critical COVID-19 was distinguished by very high levels of interleukin (IL)-1β and T lymphocyte activation (including IL-7 and CD40L), whereas septic shock displays higher levels of IL-6, IL-8, and a more significant elevation of myeloid response biomarkers, including Triggering Receptor Expressed on Myeloid cells-1 (TREM-1) and IL-1ra. Subsequent inflammation-induced coagulopathy of COVID-19 also differed from sepsis-induced coagulopathy (SIC) and was characterized by a marked increase in soluble tissue factor (TF) but less platelets, antithrombin, and fibrinogen consumption, and less fibrinolysis alteration. In conclusion, COVID-19 inflammation-induced coagulopathy substantially differs from SIC. Modulating TF release and activity should be evaluated in critical COVID-19 patients.

2021 ◽  
pp. 30-34
Author(s):  
S. S. Bayramova ◽  
O. V. Tsygankova ◽  
K. Yu. Nikolayev ◽  
O. V. Tuzovskaya

The review presents an assessment of the dynamics of the change in procalcitonin as the main marker of bacterial inflammation in patients with the syndrome of systemic inflammatory reaction, sepsis and septic shock, clarification of the practical and predictive significance of PCT in patients with an identified and not identified focus of infection.


2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
M D M Dechamps ◽  
J De Poortere ◽  
P F Laterre ◽  
M Octave ◽  
A Ginion ◽  
...  

Abstract Background Septic shock generates an important inflammatory reaction, endothelial activation and a procoagulant state leading to microvascular thrombosis and subsequent organ impairment [1]. Similarly, a severe inflammatory reaction and a coagulopathy with pulmonary micro-thrombosis eventually leading to acute lung injury, is a typical feature of critical form of Coronavirus disease 2019 (Covid-19) [2]. Our aim was to compare coagulation, platelet activation and platelets-neutrophils interplay between control, septic shock and critical Covid-19 patients. Methods/Materials A total of 118 patients were included in our prospective, monocentric, observational study between February 2019 and June 2020. Septic shock (n=48) and Covid-19 (n=22) patients were consecutively included at admission in our ICU department. Control patients (n=48) with matched gender and co-morbidities were recruited at central lab consultation. Results Septic shock patients had worse severity scores due to multiple organ failure (assessed by APACHE II and SOFA score) whereas Covid-19 patients had more severe respiratory failure and a longer ICU length-of-stay (Table 1). At the time of inclusion, CRP and lymphocyte count were comparable between septic shock and Covid-19 patients. White cell count ad neutrophil count was higher for septic shock patients. Analysis of coagulation showed a prolonged INR, TT and aPTT in septic shock although only INR was prolonged in Covid-19. Thrombin antithrombin complex (TATc) formation was similar in both pathologies, whereas consumption of antithrombin III (ATIII) and D-dimers formation was more pronounced in septic shock. Platelet count was lower in septic shock and platelet activation, assessed via plasmatic levels of soluble P-selectin (sCD62P) and Trem-like transcript 1 (sTLT-1), was more important in septic shock. Neutrophil activation and NETosis, evaluated by levels of circulating myeloperoxidase (MPO) and citrullinated histone 3 (H3-Cit), was similarly increased in both groups (Figure 1). Conclusions This study confirmed an activation of coagulation cascade, platelet activation and NETosis in both septic shock and critical Covid-19, compared with control patients. Importantly, the extent of these changes was similar or less pronounced in critical COVID-19 compared with septic shock. FUNDunding Acknowledgement Type of funding sources: Foundation. Main funding source(s): Fondation Saint Luc Figure 1


2017 ◽  
Vol 13 (2) ◽  
pp. 293-295
Author(s):  
Deepika Kapoor ◽  
Deepanshu Garg

Orofacial clefts (OFC) are one of the most common congenital problems seen with a very high incidence. It imparts a negative effect on the overall health of the child by hindering in his feeding practices, normal facial growth, development of dentition and hence speech. Infants born with orofacial clefts have oronasal communication which creates a problem with the creation of negative pressure inside the oral cavity required for suckling.The treatment for such patients is with the multidisciplinary approach but the preliminary  concern for the neonate is to help with the feeding for which a feeding appliance is given. This case report presents a case of a 3-day old infant to whom a feeding appliance was given to aid in suckling. 


2021 ◽  
pp. 088506662098780
Author(s):  
Yazan Zayed ◽  
Bashar N. Alzghoul ◽  
Momen Banifadel ◽  
Hima Venigandla ◽  
Ryan Hyde ◽  
...  

Background: There is a conflicting body of evidence regarding the benefit of vitamin C, thiamine, and hydrocortisone in combination as an adjunctive therapy for sepsis with or without septic shock. We aimed to assess the efficacy of this treatment among predefined populations. Methods: A literature review of major electronic databases was performed to include randomized controlled trials (RCTs) evaluating vitamin C, thiamine, and hydrocortisone in the treatment of patients with sepsis with or without septic shock in comparison to the control group. Results: Seven studies met our inclusion criteria, and 6 studies were included in the final analysis totaling 839 patients (mean age 64.2 ± 18; SOFA score 8.7 ± 3.3; 46.6% female). There was no significant difference between both groups in long term mortality (Risk Ratio (RR) 1.05; 95% CI 0.85-1.30; P = 0.64), ICU mortality (RR 1.03; 95% CI 0.73-1.44; P = 0.87), or incidence of acute kidney injury (RR 1.05; 95% CI 0.80-1.37; P = 0.75). Furthermore, there was no significant difference in hospital length of stay, ICU length of stay, and ICU free days on day 28 between the intervention and control groups. There was, however, a significant difference in the reduction of SOFA score on day 3 from baseline (MD −0.92; 95% CI −1.43 to −.41; P < 0.05). In a trial sequential analysis for mortality outcomes, our results are inconclusive for excluding lack of benefit of this therapy. Conclusion: Among patients with sepsis with or without septic shock, treatment with vitamin C, thiamine, and hydrocortisone was not associated with a significant reduction in mortality, incidence of AKI, hospital and ICU length of stay, or ICU free days on day 28. There was a significant reduction of SOFA score on day 3 post-randomization. Further studies with a larger number of patients are needed to provide further evidence on the efficacy or lack of efficacy of this treatment.


1992 ◽  
Vol 7 (2) ◽  
pp. 90-100 ◽  
Author(s):  
Margaret M. Parker ◽  
Mitchell P. Fink

The incidence of sepsis and septic shock has been increasing dramatically over the past 10 years. Despite advances in antimicrobial therapy, the mortality of septic shock remains very high. We review the clinical manifestations of sepsis and septic shock and describe the cardiovascular manifestations. Pathophysiology of the cardiovascular changes is discussed, and mediators believed to be involved in the pathogenesis are reviewed. Management of septic shock is also discussed, including antimicrobial therapy, supportive care, and adjunctive treatment aimed at affecting the mediators involved in producing the sepsis syndrome.


1994 ◽  
Vol 70 (4) ◽  
pp. 694-696 ◽  
Author(s):  
CC Pao ◽  
SM Kao ◽  
G-C Tang ◽  
K Lee ◽  
J Si ◽  
...  

2017 ◽  
Vol 16 (4) ◽  
pp. 9-12
Author(s):  
V. V. Boiko ◽  
P. N. Zamiatyn ◽  
Yu. N. Solovei ◽  
A. Y. Trubchanyn ◽  
V. P. Nevzorov ◽  
...  

2018 ◽  
Vol 8 (2) ◽  
pp. 119-126 ◽  
Author(s):  
X.-F. Shen ◽  
W.-X. Guan ◽  
J.-F. Du ◽  
L. V. Puzyryova

The sepsis represents life-endangering disturbances of functions of the internals caused by a dizregulyation of a macroorganism to the  infectious agent and is difficult interaction of pro-inflammatory and  antiinflammatory processes that not seldom defines the fate of  patients. The predetermining factor of a sepsis is the originator. The  immunosupression caused by the originator promotes generalization  of an infection, and the intensive bacteriemia caused by generalization leads to the accruing endotoxinemia that aggravates  immunosupression even more and leads finally to systemic inflammatory reaction — the main and most dangerous implication  of a sepsis. The syndrome of systemic inflammation with  uncontrollable emission of cytokines is the cornerstone of a sepsis.  The pathophysiology of a sepsis begins with impassioned inflammatory reaction which can last several days, and then passes  into more lingering immunosupressivny period where the outcome  depends on the immune system of the patient. Cellular apoptosis is  one of leaders in sepsis immunosupression development. In article  mechanisms of disturbance of an apoptosis of neutrophils are  described that, undoubtedly, affects weighting of a current of a  sepsis and as a result, a failure. Migration of neutrophils under  natural conditions includes four various phases which during a sepsis  are broken. The mechanisms worsening migration of  neutrophils, contributing to the development of a sepsis were  investigated in numerous scientific works. Authors of Peking  University offered schemes of a way of disturbance of an apoptosis  of neutrophils and migration of neutrophils at a sepsis. Despite the  extensive accumulated experience on studying of a pathogenesis of  septic states, there are no effective and specific remedies of fight  from a sepsis now. Perhaps, by prevention of disturbance of the  programmed death of a cell the cytokines developed anti-apoptotic,  caspase inhibitors will be. 


2018 ◽  
Vol 87 (6) ◽  
pp. AB508
Author(s):  
Daisuke Yoshimura ◽  
Toshiaki Ochiai ◽  
Shin-ichiro Fukuda ◽  
Kojiro Niho ◽  
Yusuke Kitagawa ◽  
...  

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