scholarly journals Sepsis: an update in 2018

2019 ◽  
pp. S99-S101
Author(s):  
Muhammad Fuad Bangash
Keyword(s):  
Organ Dysfunction ◽  
Host Response ◽  
The United States ◽  
Review Article ◽  
Source Control ◽  
Metabolic Dysfunction ◽  
Vasoactive Agents ◽  
Sepsis Management ◽  
Failure Assessment ◽  
Life Threatening

Sepsis remains a major source of morbidity and mortality not only in the United States but worldwide. The key to save lives of these patients is to have a multi-pronged approach to the management of sepsis. In this review article we shall go through the specifics of this approach. Sepsis is a life-threatening organ dysfunction caused by dysregulated host response to infection. The septic shock is a subset of sepsis with circulatory and cellular/metabolic dysfunction. Patients with sepsis (formerly severe sepsis) should still be identified by the same organ dysfunction criteria (including lactate level > 2 mmol/L). Organ dysfunction may also be identified using the ‘quick Sepsis-Related Organ Failure Assessment’ (qSOFA). Appropriate source control and immediate treatment with IV antibiotics is a cornerstone of sepsis management. The next step is to resuscitate patients with sepsis-induced hypoperfusion with at least 30 ml/kg of intravenous crystalloid fluid. If the patient is hypotensive despite adequate fluid resuscitation, then use of vasoactive agents like norepinephrine and vasopressin is indicated.Citation: Bangash MF. Sepsis: an update in 2018. Anaesth Pain & Intensive Care 2018;22 Suppl 1:S99-S101

scholarly journals diagnosis and trEatmEnt of patiEnts in sEptiC shoCK

New Medicine ◽  
2017 ◽  
Vol 21 (1) ◽  
pp. 31-36
Author(s):  
Jacek wadełek
Keyword(s):  
Septic Shock ◽  
Organ Dysfunction ◽  
Host Response ◽  
Signs And Symptoms ◽  
Intravenous Fluids ◽  
Failure Assessment ◽  
Acute Change ◽  
Life Threatening ◽  
Sepsis And Septic Shock ◽  
Clinical Emergency

sepsis and septic shock are a clinical emergency. sepsis is defined as a life-threatening organ dysfunction due to a dysregulated host response to infection, and organ dysfunction is defined as an acute change in sequential organ failure assessment (sofa) score greater than 2 points secondary to an infectious cause. septic shock is defined as sepsis with persisting hypotension requiring vasopressors to maintain a mean arterial pressure of 65 mm hg or higher, and blood lactate level greater than 2 mmol/l (18 mg/dl) despite adequate volume resuscitation. the diagnosis of septic shock begins with medical history and physical examination focused on the signs and symptoms of infection, with the aim of recognizing complex physiologic manifestations of shock. Clinicians should understand the importance of prompt administration of antibiotics, vasopressors and intravenous fluids aimed at restoring adequate circulation. they should also be aware of the limitations of the protocol-based therapy.

scholarly journals CORRELATION BETWEEN PRESEPSIN AND SEQUENTIAL [SEPSIS-RELATED] ORGAN FAILURE ASSESSMENT (SOFA) SCORE AS AN ORGAN DYSFUNCTION MARKER IN SEPSIS

2019 ◽  
Vol 25 (1) ◽  
pp. 47
Author(s):  
Stevi Dwiyani ◽  
Agnes Rengga Indrati ◽  
Leni Lismayanti ◽  
Adhi Kristianto S
Keyword(s):  
Organ Dysfunction ◽  
Sofa Score ◽  
Host Response ◽  
Early Stage ◽  
Cross Sectional Study ◽  
Innate Immune ◽  
Cross Sectional ◽  
Failure Assessment ◽  
Life Threatening ◽  
Cluster Of Differentiation

Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection. The latest consensus in 2016 (Sepsis-3) identified organ dysfunction as an acute change in total SOFA score ≥2 points. An ideal laboratory examination is expected to detect sepsis in an early stage and correlated with the degree of infection. Presepsin or Soluble Cluster of Differentiation 14 Sub Type (sCD14-ST) is a proteolysis product of CD14 that is produced in 1-2 hour after innate immune activation during infections. The aim of this study was to determine the correlation of presepsin and SOFA score as an organ dysfunction marker in sepsis. This research was an observational, analytical cross-sectional study conducted in the Dr. Hasan Sadikin Hospital (RSHS) Bandung from September 2016 until July 2017. The subjects were 42 patients from the Emergency Department diagnosed as sepsis by clinicians using criteria of SOFA score ≥2 points. The serum sample was collected and measured for presepsin concentration. A correlation test was analyzed with Spearman analysis. This study showed the increasing of presepsin concentration associated with SOFA score (p=0.000; r=0.660). There was a positive correlation between presepsin and SOFA score as an organ dysfunction marker

scholarly journals The Role and Mechanism of Pyroptosis and Potential Therapeutic Targets in Sepsis: A Review

2021 ◽  
Vol 12 ◽  
Author(s):  
Xiangtao Zheng ◽  
Weiwei Chen ◽  
Fangchen Gong ◽  
Ying Chen ◽  
Erzhen Chen
Keyword(s):  
Immune Response ◽  
Organ Dysfunction ◽  
Host Response ◽  
Therapeutic Targets ◽  
Host Immune Response ◽  
Unique Form ◽  
Pathogen Infection ◽  
Programmed Death ◽  
Life Threatening ◽  
Future Direction

Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection. Recently was been found that pyroptosis is a unique form of proinflammatory programmed death, that is different from apoptosis. A growing number of studies have investigated pyroptosis and its relationship with sepsis, including the mechanisms, role, and relevant targets of pyroptosis in sepsis. While moderate pyroptosis in sepsis can control pathogen infection, excessive pyroptosis can lead to a dysregulated host immune response and even organ dysfunction. This review provides an overview of the mechanisms and potential therapeutic targets underlying pyroptosis in sepsis identified in recent decades, looking forward to the future direction of treatment for sepsis.

scholarly journals Validation of PELOD-2 score as a predictor of life-threatening organ dysfunction in pediatric sepsis

2020 ◽  
Vol 60 (5) ◽  
pp. 227-32
Author(s):  
Yuyun Romaria Simanjuntak ◽  
Indra Saputra ◽  
Silvia Triratna ◽  
Achirul Bakri ◽  
Yulia Iriani
Keyword(s):  
Organ Dysfunction ◽  
Roc Curve ◽  
Area Under The Curve ◽  
Youden Index ◽  
International Consensus ◽  
Failure Assessment ◽  
Life Threatening ◽  
Sepsis Definition ◽  
Pediatric Sepsis ◽  
Sepsis And Septic Shock

Background The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) defined sepsis as life-threatening organ dysfunction due to immune dysregulation against infection. It recommends the Sequential (sepsis-related) Organ Failure Assessment (SOFA) score to evaluate life-threatening organ dysfunction. But the SOFA tool has not been adjusted for pediatric patients.  The Indonesian Pediatrics Society (IPS) uses the same sepsis definition and recommends using the PELOD-2 score as an indicator of life-threatening organ dysfunction in children.     Objective To evaluate the validity of the PELOD-2 score for predicting life-threatening organ dysfunction in pediatric sepsis. Methods A prospective cohort study was conducted in children with sepsis who were admitted to the PICU.  Subjects were taken consecutively with inclusion criteria of 1 month-18 years of age, with organ dysfunction, having two or more symptoms of systemic inflammatory response syndrome (SIRS), and suspected or proven infection.  PELOD-2 score, with and without lactate result, of each subject were plotted to receiver operating characteristic (ROC) curve, then we determined the most optimal cut off point to predict the life-threathneing organ dysfunction in pediatric sepsis based on the sensitivity and specificity of each score. Results Sixty-six patients were analyzed, with 40 males and 26 females aged 2 to 183 months (median 11 months).  Twenty patients died while in the PICU. A PELOD-2 score (with lactate) cut-off ≥ 7 was determined by ROC curve, with sensitivity of 80% and specificity of 78%. The area under the curve (AUC) of PELOD-2 score (with lactate) was 84.8% (95%CI 74.7 to 95.9%).  A PELOD-2 score (without lactate) ≥ 7  was the most optimum cut off based on its Youden index, it haD 70% of sensitivity and 80% of specificity. Conclusion PELOD-2 score ≥ 7 , with or without lactate component is the optimal cut-off for predicting life-threatening organ dysfunction in pediatric sepsis. 

scholarly journals Utility of Procalcitonin as a Biomarker for Sepsis in Children

2020 ◽  
Vol 58 (7) ◽  
Author(s):  
Kevin J. Downes ◽  
Julie C. Fitzgerald ◽  
Scott L. Weiss
Keyword(s):  
Host Response ◽  
Early Recognition ◽  
Mortality Rates ◽  
Sepsis Management ◽  
Complex Process ◽  
Significant Research ◽  
Sepsis Risk ◽  
Life Threatening ◽  
Adults And Children ◽  
Pediatric Sepsis

ABSTRACT Sepsis is a complex process defined as life-threatening organ dysfunction caused by a dysregulated host response to infection. It is associated with significant morbidity and mortality rates in both adults and children, and emphasis has been placed on its early recognition and prompt provision of antimicrobials. Owing to limitations of current diagnostic tests (i.e., poor sensitivity and delayed results), significant research has been conducted to identify sepsis biomarkers. Ideally, a biomarker could reliably and rapidly distinguish bacterial infection from other, noninfectious causes of systemic inflammatory illness. In doing so, a sepsis biomarker could be used for earlier identification of sepsis, risk stratification/prognostication, and/or guidance of antibiotic decision-making. In this minireview, we review one of the most common clinically used sepsis biomarkers, procalcitonin, and its roles in sepsis management in these three areas. We highlight key findings in the adult literature but focus the bulk of this review on pediatric sepsis. The challenges and limitations of procalcitonin measurement in sepsis are also discussed.

scholarly journals CXCL5-mediated recruitment of neutrophils into the peritoneal cavity ofGdf15-deficient mice protects against abdominal sepsis

2020 ◽  
Vol 117 (22) ◽  
pp. 12281-12287 ◽  
Author(s):  
Isa Santos ◽  
Henrique G. Colaço ◽  
Ana Neves-Costa ◽  
Elsa Seixas ◽  
Tiago R. Velho ◽  
...  
Keyword(s):  
Septic Shock ◽  
Organ Dysfunction ◽  
Peritoneal Cavity ◽  
Host Response ◽  
Abdominal Sepsis ◽  
Neutrophil Recruitment ◽  
Life Threatening ◽  
Pathogen Control ◽  
Circulating Levels ◽  
Deficient Mice

Sepsis is a life-threatening organ dysfunction condition caused by a dysregulated host response to an infection. Here we report that the circulating levels of growth and differentiation factor-15 (GDF15) are strongly increased in septic shock patients and correlate with mortality. In mice, we find that peptidoglycan is a potent ligand that signals through the TLR2-Myd88 axis for the secretion of GDF15, and thatGdf15-deficient mice are protected against abdominal sepsis due to increased chemokine CXC ligand 5 (CXCL5)-mediated recruitment of neutrophils into the peritoneum, leading to better local bacterial control. Our results identify GDF15 as a potential target to improve sepsis treatment. Its inhibition should increase neutrophil recruitment to the site of infection and consequently lead to better pathogen control and clearance.

scholarly journals An assessment of knowledge and education about sepsis among medical students: a multi-university survey

2021 ◽  
Vol 23 (1) ◽  
pp. 117-118
Author(s):  
Rachit Datta ◽  
◽  
Gian Luca Di Tanna ◽  
Amanda Harley ◽  
Luregn J Schlapbach ◽  
...  
Keyword(s):  
Critical Illness ◽  
Medical Students ◽  
Organ Dysfunction ◽  
Host Response ◽  
Medical Schools ◽  
Junior Doctors ◽  
Life Threatening ◽  
Time Critical ◽  
Australian Universities

Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection; it affects 55 000 Australians and results in around 8700 deaths annually.1 Studies have shown that junior doctors have reduced awareness of the importance of sepsis as a time-critical illness.2 Whether this deficiency is a consequence of insufficient training on sepsis in medical schools is unknown. This study evaluated the knowledge of sepsis among medical students in two Australian universities

scholarly journals Recent application of metabolomics in the diagnosis, pathogenesis, treatment, and prognosis of sepsis

2021 ◽  
Keyword(s):  
Early Diagnosis ◽  
Organ Dysfunction ◽  
Host Response ◽  
Clinical Manifestations ◽  
Rapid Diagnosis ◽  
Pathophysiological Mechanism ◽  
Recent Application ◽  
Biochemical Pathways ◽  
Diagnosis And Prognosis ◽  
Life Threatening

Sepsis is a life-threatening organ dysfunction caused by dysregulated host response to infections. It is a leading cause of morbidity and mortality in hospitalized patients. Patients with sepsis often require care in the intensive care unit (ICU) which is costly to the patients and their families. Sepsis has no specific clinical manifestations, and its pathophysiological mechanism is complex. The disease progresses rapidly which makes early diagnosis difficult. Severe forms of the disease, such as septic shock, may lead to organ dysfunction, organ failure, and death. As an emerging “-omics” technology, metabolomics has revolutionized the clinical and research landscape of sepsis. Metabolomics has been applied in the prognosis, diagnosis, and risk stratification in patients with sepsis. This technology provides details on the metabolites and biochemical pathways commonly associated with the pathophysiology of sepsis. At present, it is mostly used to identify metabolites in various diseases. Using this technology, metabolites in body fluids such as blood and urine are detected and analyzed in relation to disease progresssion. The technology therefore helps to understand the pathogenesis of diseases and promote early diagnosis and treatment of the disease. So far, the applicaition of metabolomics in patients with sepsis has not been well defined. This article briefly reviews the application of metabolomics technology in patients with sepsis in recent years, to generate ideas for improving rapid diagnosis and prognosis evaluation of patients with sepsis.

scholarly journals Pathologic Difference between Sepsis and Bloodstream Infections

2019 ◽  
Vol 3 (4) ◽  
pp. 654-663 ◽  
Author(s):  
Luis E Huerta ◽  
Todd W Rice
Keyword(s):  
Mitochondrial Dysfunction ◽  
Organ Dysfunction ◽  
Host Response ◽  
Laboratory Tests ◽  
Bloodstream Infections ◽  
Therapeutic Interventions ◽  
Coagulation Cascade ◽  
Sepsis Diagnosis ◽  
Reactive Protein ◽  
Life Threatening

Abstract Background Sepsis, defined as life-threatening organ failure caused by a dysregulated host response to infection, is a major cause of morbidity and mortality in hospitalized patients. Understanding the features that distinguish sepsis from bloodstream infections (and other types of infection) can help clinicians appropriately and efficiently target their diagnostic workup and therapeutic interventions, especially early in the disease course. Content In this review, sepsis and bloodstream infections are both defined, with a focus on recent changes in the sepsis definition. The molecular and cellular pathways involved in sepsis pathogenesis are described, including cytokines, the coagulation cascade, apoptosis, and mitochondrial dysfunction. Laboratory tests that have been evaluated for their utility in sepsis diagnosis are discussed. Summary Sepsis is defined not only by the presence of an infection, but also by organ dysfunction from a dysregulated host response to that infection. Numerous pathways, including proinflammatory and antiinflammatory cytokines, the coagulation cascade, apoptosis, and mitochondrial dysfunction, help determine if a bloodstream infection (or any other infection) progresses to sepsis. Many biomarkers, including C-reactive protein, procalcitonin, and lactic acid have been evaluated for use in sepsis diagnosis, although none are routinely recommended for that purpose in current clinical practice. While some laboratory tests can help distinguish the 2, the presence of organ dysfunction is what separates sepsis from routine infections.

scholarly journals Extracellular Vesicles: A Double-Edged Sword in Sepsis

2021 ◽  
Vol 14 (8) ◽  
pp. 829
Author(s):  
Marlies Burgelman ◽  
Charysse Vandendriessche ◽  
Roosmarijn E. Vandenbroucke
Keyword(s):  
Clinical Outcome ◽  
Organ Dysfunction ◽  
Extracellular Vesicles ◽  
Host Response ◽  
Current Knowledge ◽  
Healthy Controls ◽  
Lymphocyte Apoptosis ◽  
Cellular Source ◽  
Life Threatening

Sepsis is defined as a life-threatening organ dysfunction caused by a dysregulated host response to an infection. Several studies on mouse and patient sepsis samples have revealed that the level of extracellular vesicles (EVs) in the blood is altered compared to healthy controls, but the different functions of EVs during sepsis pathology are not yet completely understood. Sepsis EVs are described as modulators of inflammation, lymphocyte apoptosis, coagulation and organ dysfunction. Furthermore, EVs can influence clinical outcome and it is suggested that EVs can predict survival. Both detrimental and beneficial roles for EVs have been described in sepsis, depending on the EV cellular source and the disease phase during which the EVs are studied. In this review, we summarize the current knowledge of EV sources and functions during sepsis pathology based on in vitro and mouse models, as well as patient samples.

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