A pulmonary source of infection in patients with sepsis-associated acute kidney injury leads to a worse outcome and poor recovery of kidney function

Fan, Yiwen; Jiang, Shaowei; Chen, Jiameng; Wang, Huiqi; Liú, Dan; Pan, Shuming; Gao, Chengjin

doi:10.5847/wjem.j.1920-8642.2020.01.003

Cited by 15 publications

(16 citation statements)

References 40 publications

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“…ALI can easily occur in the early stage of sepsis due to the involvement of the lungs in suppurative inflammation [9]. And there are many potential pathogens that can cause sepsis [10]. More importantly, there is no drug or treatment that can effectively cure sepsis [11].…”

Section: Introductionmentioning

confidence: 99%

Adipose-derived mesenchymal stem cells attenuate acute lung injury and improve the gut microbiota in septic rats

et al. 2020

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Background We hypothesized that adipose-derived mesenchymal stem cells (ADMSCs) may ameliorate sepsis-induced acute lung injury (ALI) and change microorganism populations in the gut microbiota, such as that of Firmicutes and Bacteroidetes. Methods A total of 60 male adult Sprague-Dawley (SD) rats were separated into three groups: the sham control (SC) group, the sepsis induced by cecal ligation and puncture (CLP) group, and the ADMSC treatment (CLP-ADMSCs) group, in which rats underwent the CLP procedure and then received 1 × 106 ADMSCs. Rats were sacrificed 24 h after the SC or CLP procedures. To study the role of ADMSCs during ALI caused by sepsis and examine the impact of ADMSCs on the gut microbiome composition, rat lungs were histologically evaluated using hematoxylin and eosin (H&E) staining, serum levels of pro-inflammatory factors were detected using enzyme-linked immunosorbent assay (ELISA), and fecal samples were collected and analyzed using 16S rDNA sequencing. Results The serum levels of inflammatory cytokines, tumor necrosis factor (TNF)-α and interleukin (IL)-6, were significantly increased in rats after the CLP procedure, but were significantly decreased in rats treated with ADMSCs. Histological evaluation of the rat lungs yielded results consistent with the changes in IL-6 levels among all groups. Treatment with ADMSCs significantly increased the diversity of the gut microbiota in rats with sepsis. The principal coordinates analysis (PCoA) results showed that there was a significant difference between the gut microbiota of the CLP-ADMSCs group and that of the CLP group. In rats with sepsis, the proportion of Escherichia–Shigella (P = 0.01) related to lipopolysaccharide production increased, and the proportion of Akkermansia (P = 0.02) related to the regulation of intestinal mucosal thickness and the maintenance of intestinal barrier function decreased. These changes in the gut microbiota break the energy balance, aggravate inflammatory reactions, reduce intestinal barrier functions, and promote the translocation of intestinal bacteria. Intervention with ADMSCs increased the proportion of beneficial bacteria, reduced the proportion of harmful bacteria, and normalized the gut microbiota. Conclusions Therapeutically administered ADMSCs ameliorate CLP-induced ALI and improves gut microbiota, which provides a potential therapeutic mechanism for ADMSCs in the treatment of sepsis.

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Section: Introductionmentioning

confidence: 99%

Adipose-derived mesenchymal stem cells attenuate acute lung injury and improve the gut microbiota in septic rats

et al. 2020

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“…The innate immunity and acquired immunity of the body can regulate the immune imbalance. Neutrophils, monocytes, macrophages and pathogens arrive at the site of an inflammatory reaction in large numbers, leading to tissue and vascular endothelial damage, and progress to organ failure, coagulation dysfunction and blood flow instability [9,10]. It can act on bacteria directly by secreting antimicrobial peptide, and indirectly mediate by increasing phagocytic activity of macrophages and neutrophils.…”

Section: Sepsismentioning

confidence: 99%

Mesenchymal Stem Cells in Sepsis: From Basic Research to Clinical Application

Sun¹,

Ding²,

Sun³

2021

ICRES

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Sepsis is a life-threatening organ dysfunction caused by a deregulated host response to infection, and is the most common cause of death in the intensive care unit. Although the pathogenesis of sepsis has made substantial progress, the current clinical treatment of sepsis is basically symptomatic treatment, including the infusion of antibiotics and catecholamine, and no effective conventional treatment has been found. The focus of research is Mesenchymal Stem Cells (MSCs). It can be a novel therapeutic tool to treat sepsis. MSCs have the characteristics of anti-inflammatory, antibacterial, anti-apoptosis, regulating immunity, and tissue and organ repair. The pre-clinical research and a few clinical phase I studies are reviewed to review the current cell therapy for sepsis. Using the characteristics of MSCs provides new ideas for the treatment of sepsis.

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“…However, effective treatment is still lacking despite conventional management strategies, such as the limitation of tidal volume, maintenance of adequate high positive end-expiratory pressure (PEEP), advanced infection management, and supportive therapies. [3,4] Our previous study [5] indicated that corticosteroids could decrease the risk of ARDS in community-acquired pneumonia patients. Corticosteroids have also been reported to reduce the 28-day mortality rate in septic patients.…”

Section: Introductionmentioning

confidence: 99%

Efficacy and safety of low-dose corticosteroids for acute respiratory distress syndrome: A systematic review and meta-analysis

Cui¹,

Ding²,

Liang³

et al. 2021

World Journal of Emergency Medicine

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BACKGROUND: There are confl icting results regarding whether corticosteroids have better effi cacy than placebo in acute respiratory distress syndrome (ARDS) patients. Therefore, we aim to further evaluate the effi cacy and safety of corticosteroids in adult ARDS patients. METHODS:The databases, including Medline, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library, were searched from their inception to May 2, 2020. Randomized controlled trials (RCTs) and observational cohort studies were selected to assess the use of corticosteroids in adult ARDS patients. The quality of the results was judged by the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. The inverse-variance method with random or fixed effects modeling was used to compute pooled odds ratio (OR), standardized mean diff erence (SMD), and their 95% confi dence interval (CI). RESULTS:Eight eligible RCTs and six cohort studies were included. The use of corticosteroids was associated with reduced mortality (OR 0.57, 95% CI 0.43-0.76, I 2 =35.1%, P=0.148) in ARDS patients, and the result was confirmed in the included cohort studies (OR 0.51, 95% CI 0.27-0.95, I 2 =66.7%, P=0.010). The subgroup analysis stratified by the initiation time and duration of corticosteroid use showed that early ARDS and prolonged corticosteroid use had signifi cant survival benefits in the RCTs. The low-dose corticosteroid use was also associated with significantly more ventilator-free days and a reduced rate of new infections in ARDS patients. CONCLUSIONS:The low-dose corticosteroid therapy may be safe and reduce mortality, especially in patients with prolonged treatment and early ARDS.

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A pulmonary source of infection in patients with sepsis-associated acute kidney injury leads to a worse outcome and poor recovery of kidney function

Cited by 15 publications

References 40 publications

Adipose-derived mesenchymal stem cells attenuate acute lung injury and improve the gut microbiota in septic rats

Adipose-derived mesenchymal stem cells attenuate acute lung injury and improve the gut microbiota in septic rats

Mesenchymal Stem Cells in Sepsis: From Basic Research to Clinical Application

Efficacy and safety of low-dose corticosteroids for acute respiratory distress syndrome: A systematic review and meta-analysis

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