Edited by: Dr Yong-Ming Yao, Prof Timothy R. Billiar
Sepsis with subsequent multiple organ dysfunction is a pronounced systemic inflammatory response to concealed or known infection. It is one of the leading causes of ICU admissions, which affects patients of all ages with multiple comorbidities and underlying diagnoses, and is the result of infection by many potential pathogens infecting various organs or sites.
The pathogenesis of sepsis remains poorly understood although it is attributable to dysregulated immune responses orchestrated by innate immune cells that sequentially release early and late pro-inflammatory mediators. Recent studies proved that VE-cadherin cleavage, weak or absent type IV collagen expression and elevated L-arginine and ADMA levels appear to be of clinical relevance in patients with severe sepsis or septic shock. These many molecules have been clinically tested, however, no beneficial effects on outcomes in heterogeneous populations of patients have been determined.
Mounting evidence in both animal models and human studies suggests that sepsis induces a higher mortality, cognitive decline (e.g. dementia), progressive immunosuppression, cholinergic anti-inflammatory deficiency, metabolic and hydroelectrolyte imbalance.
Current sepsis therapies are largely supportive and limited to a few clinical interventions, including antibiotics, steroidal anti-inflammatory drugs (e.g., hydrocortisone) and early goal-directed therapies (EGDT). Despite improved overall management for sepsis, no strategies have yet been persistently shown to have beneficial effects on outcomes, and therefore mortality and morbidity rates remain high.
In this thematic series, we would like to generate an international view of sepsis across the globe, with special focus on the predictive and prognostic biomarkers, pathogenesis/mechanisms of sepsis, sepsis-induced sequelae, and therapeutic approaches and interventional strategies.
Collection published: 27 September 2016