Focus on sepsis: new concepts and findings in sepsis care

Timsit, Jean François; Ruppé, Étienne; Ferrer, Ricard

doi:10.1007/s00134-018-5406-3

Cited by 8 publications

(6 citation statements)

References 21 publications

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Section: Introductionmentioning

confidence: 99%

“…1 The host response in sepsis is characterized by extensive activation of immune cells and alterations in the coagulation system. 2 The interaction between the coagulation system, inflammatory reactions, and the immune system during sepsis has attracted much attention. 3,4 As previous studies of sepsis found coagulopathy to be quite common in individuals with sepsis, a new concept of sepsisinduced coagulopathy (SIC) was put forward to address the importance of coagulopathy in the pathogenesis of sepsis.…”

Section: Introductionmentioning

confidence: 99%

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The Value of Thromboelastography in the Diagnosis of Sepsis-Induced Coagulopathy

Luo

Gong

et al. 2020

Clin Appl Thromb Hemost

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Thromboelastography (TEG) is regularly used for monitoring abnormalities of the coagulation system in patients with sepsis. However, it is unclear whether TEG parameters are associated with sepsis-induced coagulopathy (SIC). Thus, we aimed to assess the diagnostic value of TEG for SIC. The medical records of patients who underwent TEG from January 2016 to December 2016 were analyzed retrospectively. The patients were divided into sepsis group and non-sepsis group. Baseline patient characteristics and coagulation function indexes were compared. Receiver–operating characteristic curve analysis was used to determine predictors of SIC. A total of 167 patients were included, of whom 84 had sepsis. The clot formation speed (K) was significantly higher(P < 0.001), and the maximum amplitude (MA) and angle were significantly lower (both P < 0.001) in the sepsis group than that in non-sepsis group. Patients with SIC had higher Sepsis-related Organ Failure Assessment scores than those patients without SIC (P < 0.001). The area under the curve of K for diagnosing SIC was 0.910. The area under the curve of angle and MA for excluding SIC was 0.895 and 0.882, respectively. Thus, TEG parameters have good diagnostic value for SIC.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The Value of Thromboelastography in the Diagnosis of Sepsis-Induced Coagulopathy

Luo

Gong

et al. 2020

Clin Appl Thromb Hemost

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“…Improved treatment protocols and updated organ support equipment have resulted in the majority of patients surviving the initial 72 h of sepsis only to succumb later in the time course of the disease (30, 31). The failure of several high-profile clinical trials in sepsis has led basic and clinical researchers to state that sepsis studies need a new direction, and there is increasing recognition that a state of impaired immunity follows the initial hyperinflammatory phase of sepsis (8, 10, 27, 32). An important feature of immunosuppression is T cell exhaustion, which was recently recognized following many trials for sepsis involving immunoregulatory therapies, such as PD-1 blockade, interleukin 7 administration, interleukin 15 administration, IFN-γ administration, and CTLA-4 blockade (2, 21, 31, 33).…”

Section: Discussionmentioning

confidence: 99%

Different Expression Characteristics of LAG3 and PD-1 in Sepsis and Their Synergistic Effect on T Cell Exhaustion: A New Strategy for Immune Checkpoint Blockade

Niu

Zhou

et al. 2019

Front. Immunol.

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The impairment of immunity characterized by T cell exhaustion is the main cause of death in patients with sepsis after the acute phase. Although PD-1 blockade is highly touted as a promising treatment for improving prognosis, the role of PD-1 plays in sepsis and particularly its different roles in different periods are still very limited. A recent study revealed LAG3 can resist the therapeutic effect of PD-1 blockade in tumor, which inspired us to understand their role in sepsis. We enrolled 26 patients with acute sepsis from 422 candidates using strict inclusion criteria. Follow-up analysis revealed that the expression levels of PD-1 were rapidly increased in the early stage of sepsis but did not change significantly as infection continued ( P < 0.05). However, the expression of LAG3 was contrary to that of PD-1. Compared with LAG3 or PD-1 single-positive T cells, T cells coexpressing LAG3 and PD-1 were significantly exhausted ( P < 0.05). The proportion of coexpressing T cells was negatively correlated with the total number of lymphocytes ( r = −0.653, P = 0.0003) and positively correlated with the SOFA score ( r = 0.712, P < 0.0001). In addition, the higher the proportion of coexpressing T cells was, the longer the hospital stay and the higher the mortality. These results showed that LAG3 and PD-1 had a potential synergistic effect in regulating the gradual exhaustion of T cells in sepsis, which seriously affected the clinical prognosis of patients. Therefore, LAG3 and PD-1 double-positive T cells are an important indicator for immunity detection and prognostic evaluation. In the future, precision therapy may pay more attention to the different expression patterns of these two molecules.

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“…Therefore, it is promising to design nanomaterials that block the NLR-mediated signaling pathway or both the TLR and NLR-mediated signaling pathways for the treatment of sepsis. Finally, many bacteria develop multidrug resistance and develop immune escape mechanisms in response to the host immune response and the abuse of antibiotic therapy [ [161] , [162] , [163] ]. Particularly in the immunosuppressive stage of late sepsis, there is a very complicated and contradictory relationship between regulating the level of inflammation and killing pathogens.…”

Section: Summary and Prospectsmentioning

confidence: 99%

Nanotherapies for sepsis by regulating inflammatory signals and reactive oxygen and nitrogen species: New insight for treating COVID-19

et al. 2021

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SARS-CoV-2 has caused up to 127 million cases of COVID-19. Approximately 5% of COVID-19 patients develop severe illness, and approximately 40% of those with severe illness eventually die, corresponding to more than 2.78 million people. The pathological characteristics of COVID-19 resemble typical sepsis, and severe COVID-19 has been identified as viral sepsis. Progress in sepsis research is important for improving the clinical care of these patients. Recent advances in understanding the pathogenesis of sepsis have led to the view that an uncontrolled inflammatory response and oxidative stress are core factors. However, in the traditional treatment of sepsis, it is difficult to achieve a balance between the inflammation, pathogens (viruses, bacteria, and fungi), and patient tolerance, resulting in high mortality of patients with sepsis. In recent years, nanomaterials mediating reactive oxygen and nitrogen species (RONS) and the inflammatory response have shown previously unattainable therapeutic effects on sepsis. Despite these advantages, RONS and inflammatory response-based nanomaterials have yet to be extensively adopted as sepsis therapy. To the best of our knowledge, no review has yet discussed the pathogenesis of sepsis and the application of nanomaterials. To help bridge this gap, we discuss the pathogenesis of sepsis related to inflammation and the overproduction RONS, which activate pathogen-associated molecular pattern (PAMP)-pattern recognition receptor (PRR) and damage-associated molecular pattern (DAMP)-PRR signaling pathways. We also summarize the application of nanomaterials in the treatment of sepsis. As highlighted here, this strategy could synergistically improve the therapeutic efficacy against both RONS and inflammation in sepsis and may prolong survival. Current challenges and future developments for sepsis treatment are also summarized.

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Focus on sepsis: new concepts and findings in sepsis care

Cited by 8 publications

References 21 publications

The Value of Thromboelastography in the Diagnosis of Sepsis-Induced Coagulopathy

The Value of Thromboelastography in the Diagnosis of Sepsis-Induced Coagulopathy

Different Expression Characteristics of LAG3 and PD-1 in Sepsis and Their Synergistic Effect on T Cell Exhaustion: A New Strategy for Immune Checkpoint Blockade

Nanotherapies for sepsis by regulating inflammatory signals and reactive oxygen and nitrogen species: New insight for treating COVID-19

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