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Sepsis and Septic Shock

Edited by: Dr Yong-Ming Yao and Dr Jie Fan

Sepsis is life-threatening organ dysfunction caused by dysregulated host response to infection according to the 2016 guidelines issued by the Surviving Sepsis Campaign. 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. As thus, it causes a great global healthcare burden, especially to the developing and under-developed countries and regions.

Septic shock is a subset of sepsis with circulatory and cellular/metabolic dysfunction. It is one of the most challenging medical problems and carries a higher mortality than sepsis, ranging from 20% to 50%, in general ICU populations. Despite adequate and emergent fluid resuscitation, septic shock affects between 10% and 30% of patients managed in the ICU, and its incidence is still increasing.

Although most of the patients were managed in ICU, a series of questions remained. A rapid diagnosis and accurate diagnosis of sepsis and septic shock is still difficult in routine clinical practice. 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. Moreover, three trials, ARISE, ProCESS and ProMISe, revealed that EGDT did not lead to an improvement in outcome in septic patients. 

In this thematic series, we would like to raise an early and rapid recognition of sepsis and septic shock across the globe.

This series was published in Military Medical Research.

  1. Sepsis, a severe systemic inflammatory response to infection, remains a leading cause of morbidity and mortality worldwide. Exosomes, as mediators of intercellular communication, play a pivotal role in the pat...

    Authors: Ting Gong, You-Tan Liu and Jie Fan
    Citation: Military Medical Research 2024 11:24
  2. Sustained yet intractable immunosuppression is commonly observed in septic patients, resulting in aggravated clinical outcomes. However, due to the substantial heterogeneity within septic patients, precise ind...

    Authors: Ren-Qi Yao, Peng-Yue Zhao, Zhi-Xuan Li, Yu-Yang Liu, Li-Yu Zheng, Yu Duan, Lu Wang, Rong-Li Yang, Hong-Jun Kang, Ji-Wei Hao, Jing-Yan Li, Ning Dong, Yao Wu, Xiao-Hui Du, Feng Zhu, Chao Ren…
    Citation: Military Medical Research 2023 10:27

    The Commentary to this article has been published in Military Medical Research 2023 10:28

  3. Sepsis involves life-threatening organ dysfunction and is caused by a dysregulated host response to infection. No specific therapies against sepsis have been reported. Celastrol (Cel) is a natural anti-inflamm...

    Authors: Piao Luo, Qian Zhang, Tian-Yu Zhong, Jia-Yun Chen, Jun-Zhe Zhang, Ya Tian, Liu-Hai Zheng, Fan Yang, Ling-Yun Dai, Chang Zou, Zhi-Jie Li, Jing-Hua Liu and Ji-Gang Wang
    Citation: Military Medical Research 2022 9:22
  4. Septic shock has a high incidence and mortality rate in Intensive Care Units (ICUs). Earlier intravenous fluid resuscitation can significantly improve outcomes in septic patients but easily leads to fluid over...

    Authors: Mei-Ping Wang, Li Jiang, Bo Zhu, Bin Du, Wen Li, Yan He and Xiu-Ming Xi
    Citation: Military Medical Research 2021 8:40
  5. Fluid overload (FO) after resuscitation is frequent and contributes to adverse outcomes among postinjury open abdomen (OA) patients. Bioelectrical impedance analysis (BIA) is a promising tool for monitoring fl...

    Authors: Kai Wang, Shi-Long Sun, Xin-Yu Wang, Cheng-Nan Chu, Ze-Hua Duan, Chao Yang, Bao-Chen Liu, Wei-Wei Ding, Wei-Qin Li and Jie-Shou Li
    Citation: Military Medical Research 2021 8:36
  6. In modern warfare, therapy for combat injury is a critical issue to improve personnel survival and battle effectiveness. Be limited to the severe circumstance in the distant battlefield, quick and effective tr...

    Authors: Yong-ming Yao and Hui Zhang
    Citation: Military Medical Research 2019 6:23
  7. With improvements in personnel and vehicular body armor, robust casualty evacuation capabilities, and damage control resuscitation strategies, more combat casualties are surviving to reach higher levels of car...

    Authors: Kelly B. Thompson, Luke T. Krispinsky and Ryan J. Stark
    Citation: Military Medical Research 2019 6:11
  8. Despite efforts in prevention and intensive care, trauma and subsequent sepsis are still associated with a high mortality rate. Traumatic injury remains the main cause of death in people younger than 45 years ...

    Authors: Florian Bösch, Martin K. Angele and Irshad H. Chaudry
    Citation: Military Medical Research 2018 5:35
  9. Acute lung injury (ALI) is a major component of multiple organ dysfunction syndrome (MODS) following pulmonary and systemic infection. Alveolar macrophages (AMϕ) are at the center of ALI pathogenesis. Emerging...

    Authors: Zhi-Gang Li, Melanie J. Scott, Tomasz Brzóska, Prithu Sundd, Yue-Hua Li, Timothy R. Billiar, Mark A. Wilson, Ping Wang and Jie Fan
    Citation: Military Medical Research 2018 5:24