Actual problems of the pathology of sepsis: 25 years in search of a consensus

Od, Mishnev; Гринберг, Л. М.; Zayratyants, O. V.

doi:10.17116/patol20167863-8

Cited by 10 publications

(3 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Таким образом, отличительной особенностью СШ от сепсиса без шока явилось распространенное слущивание эндотелиоцитов в просвет сосудов (p=0.01), более частое обнаружение тромбов в сосудах миокарда и гиалиновых мембран в легких (p=0.01 и p=0.02), а также сладж-феномена в миокарде (p=0.009). Представленные морфологические особенности поражения органов согласуются с данными о патогенезе СШ [2,5,6], возникновение которого связано с воздействием эндотоксина грамотрицательных бактерий на эндотелий сосудов [1]. В результате происходит закономерная активация свертывающей системы и развитие лейкоцитарных стазов.…”

Section: результаты и их обсуждениеunclassified

“…Сепсис -жизнеугрожающее состояние, требующее особого подхода в диагностике и лечении ввиду сложности этиопатогенеза, наличия многочисленных звеньев развития, а также зависимости течения, как от состояния организма-хозяина, так и от этиологического фактора, вызвавшего его. В 2016 г. были подведены итоги 3-го международного консенсуса по сепсису и септическому шоку под названием «Сепсис -3» [2]. Септический шок (СШ) был определен как особая клиническая форма сепсиса с глубокими циркуляторными и метаболическими нарушениями, требующими использования вазопрессоров на протяжении более одного часа для восстановления уровня среднего артериального давления выше 65 мм рт.…”

Section: Introductionunclassified

See 1 more Smart Citation

Pathomorphological Characteristics of Septic Shock in Modern Therapy

Чирский

Андреева

Yuzvinkevich

et al. 2020

Žurnal anatomii i gistopatologii

View full text Add to dashboard Cite

The aim of this study was to identify the morphological features of organ damage due to shock in deceased with different types of sepsis under modern complex therapy.Material and methods. We studied archival material of 93 autopsies of the deceased with a clinical diagnosis of sepsis. Microscopic examination assessed the frequency among the observed groups and the prevalence of signs of damage to the microvasculature vessels, as well as organ parenchyma: myocardium, liver, kidneys, and brain. Statistical processing of the obtained data was carried out with the determination of significant differences between the observed groups.Results. 4 observation groups were distinguished: the first group with leukocyte mini-foci and shock (n=10), the second group with mini-foci without shock (n=11), the third group without purulent metastases with shock (n=15), the fourth group without purulent metastases without shock (n=43). It was revealed that the main etiological factor of septic shock is gram-negative microflora. It was found that in septic shock, the activation of the coagulation system is more pronounced, which is confirmed by the greater frequency of detection of blood clots in the lumen of microvasculature blood vessels. In the deceased groups with shock and leukocyte mini-foci leukostasis in the kidney vessels and desquamation of the endothelium were detected reliably (p = 0.01 and p = 0.01) more often than in the group with shock without purulent metastases.Conclusion. Septic shock is detected in every fourth (26%) deceased with this pathology. Septic shock development is based on the hyperergic response of the body to a generalized gram-negative infection, in 64% of cases presented by Klebsiella pneumonia. Septic shock is characterized by decrease in arteriole tone, absence or minimal manifestations of purulent metastasis , more severe damage to the vessels of the microcirculatory bed, manifested through the widespread exfoliation of endotheliocytes in the lumen of the vessels, frequent development of a sludge phenomenon and blood clots in the vessels of the myocardium, as well as hyaline membranes in the lungs. The detection of at least minimal manifestations of purulent metastasis in the tissues of those who died from septic shock is associated with increased expression of adhesive molecules in the myocardial vascular endothelium, its desquamation, and the appearance of leukostasis in the kidneys. These few morphological differences are associated with the nature of the patient's body reaction to a generalized infection and, accordingly, the rate of its development.

show abstract

Section: результаты и их обсуждениеunclassified

Section: Introductionunclassified

Pathomorphological Characteristics of Septic Shock in Modern Therapy

Чирский

Андреева

Yuzvinkevich

et al. 2020

Žurnal anatomii i gistopatologii

View full text Add to dashboard Cite

show abstract

“…Due to the complexity of sepsis, its specific pathogenesis is still unclear. However, sepsis has been associated with excessive release of inflammatory mediators and immune dysfunction, as well as tissue damage and gene polymorphism (Mishnev et al 2016;Shankar-Hari 2017). Sepsis is mainly treated by infection control, hormone therapy, and endotoxin targeted therapy, but the mortality of patients with sepsis has not been effectively reduced (Raghu et al 2017).…”

Section: Introductionmentioning

confidence: 99%

Expression and significance of HMGB1 in patients with sepsis and effects on prognosis

et al. 2020

View full text Add to dashboard Cite

This study explored the expression of high mobility group box 1 protein (HMGB1) expression in patients with sepsis and its effects on immune function and prognosis. Patients with sepsis (n = 112) were divided into the mild group (MG, n = 59) and severe group (SG, n = 53) according to the disease severity of sepsis. Fifty healthy people who came to our hospital for physical examination at the same time served as the control group (CG). Serum HMGB1, CD4+, and CD8+ expression levels and CD4+/CD8+ ratios were compared between the three groups. The correlation between serum HMGB1 expression, APACHE II score, and MODS score was analyzed. Serum HMGB1 and CD8+ expressions were lower in the CG group than the values in the MG and SG groups, whereas the CD4+ expression and CD4+/CD8+ ratio were higher. Serum HMGB1 expression in sepsis patients was positively correlated with the APACHEII and MODS scores. In addition, the 28-day survival rate of the MG was higher than that of the SG. HMGB1 was highly expressed in the serum of patients with sepsis. HMGB1 expression was positively associated with the severity of sepsis. In addition, HMGB1 was closely related to the immune function and prognosis of patients with sepsis. ARTICLE HISTORY

show abstract

Value of evaluating procalcitonin kinetics in diagnosis of infections in patients undergoing laparoscopic radical cystectomy

Ding

Yang

et al. 2017

Medicine

View full text Add to dashboard Cite

Postsurgery infection is a common complication after laparoscopic radical cystectomy (LRC) followed by urinary diversion. White blood cell (WBC) values and C-reactive protein (CRP) are routinely used as markers for infection, but lack of specificity and their elevation is often delayed in clinically significant events. In this study, we aimed to investigate the value of procalcitonin (PCT) kinetics in assisting early diagnosis of infection in patients undergoing LRC.The patients’ medical records between May 2013 and May 2016 were reviewed retrospectively. WBC, CRP, and PCT plasma levels as well as clinical symptoms were registered in 306 patients preoperatively (day 0), and 5 consecutive days postoperatively. Based on microbiological and clinical data, patients were grouped into noninfection- (NI-) and infection- (I-) groups. The day of new onset infection was observed were defined as day t0 and the day after that as day t1. For the NI-group, the day on which PCT was at the peak was defined as day t1 and the previous day as day t0.Of the 306 patients, 46 (15.03%) have proven infection. PCT levels were analogous at day t0:NI-group [median (interquartile range)]: 0.69(1.99) vs I-group [median (interquartile range)]: 1.0[0.75], P = .1. PCT levels were significantly increased at day t1 in the I-group[median (interquartile range)]:2.9(1.3) vs NI-group[median (interquartile range)]: 1.3(1.5), P < .01. The area under the curve for the prediction of infection was 0.72 [95% confidence interval (CI) = 0.63–0.81] for the absolute value of PCT; and for delta PCT:0.88 (95% CI = 0.81–0.94), P < .01. The optimal cut-off value was 0.79 ng/mL with the highest Youden index of 0.80 for delta-PCT to indicate infection. Neither absolute values nor changes in CRP, or WBC could predict infection better. The “delta” was considered as the changes in the absolute values (subtracting day t0 from day t1) of PCT, CRP, and WBC.This study suggest that early elevation of PCT within the first 24 hours of new onset infection, interpreted with clinical results, appears to be a promising indicator for the diagnosis of infections following LRC.

show abstract

Actual problems of the pathology of sepsis: 25 years in search of a consensus

Cited by 10 publications

References 17 publications

Pathomorphological Characteristics of Septic Shock in Modern Therapy

Pathomorphological Characteristics of Septic Shock in Modern Therapy

Expression and significance of HMGB1 in patients with sepsis and effects on prognosis

Value of evaluating procalcitonin kinetics in diagnosis of infections in patients undergoing laparoscopic radical cystectomy

Contact Info

Product

Resources

About