Sepsis: A New Hypothesis for Pathogenesis of the Disease Process

Bone, Roger C.; Grodzin, Charles J.; Balk, R.A.

doi:10.1378/chest.112.1.235

Cited by 837 publications

(528 citation statements)

References 48 publications

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“…[1][2][3][4][5] The sepsis syndrome results from a generalized inflammatory and procoagulant response to infection. 6 Activated protein C, an endogenous protein with antithrombotic, pro-fibrinolytic, and anti-inflammatory properties, is an important modulator of the coagulation and inflammatory derangements during severe sepsis. 7,8 Low levels of protein C occur in severe sepsis and are predictive of poor outcome.…”

Section: Discussionmentioning

confidence: 99%

Septic shock and multiple organ failure after hematopoietic stem cell transplantation: treatment with recombinant human activated protein C

Pastores

Papadopoulos

Brink

et al. 2002

Bone Marrow Transplant

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Summary:Severe sepsis with multiple organ failure after hematopoietic stem cell transplantation (HSCT) results in extremely high morbidity and mortality. Recent studies have highlighted the importance of sepsis-induced activation of the coagulation system in the pathophysiology of severe sepsis. Activated protein C is an important modulator of coagulation and inflammatory derangements during severe sepsis. Low levels of protein C occur in severe sepsis and are predictive of poor outcome. Recombinant human activated protein C (drotrecogin alfa (activated)) was recently approved by the Food and Drug Administration (FDA) for severe sepsis. The phase III trial that resulted in the approval of this agent, however, enrolled a general sepsis population and excluded patients undergoing HSCT. We report a case of fulminant septic shock and multiple organ failure after HSCT that was treated with drotrecogin alfa (activated) in addition to standard therapy, and recovered. The high mortality rates of patients who develop severe sepsis after HSCT demand that new avenues of treatment be considered for this very highrisk patient population. This case illustrates the potential application of a novel therapeutic approach. Clinical trials are warranted to further investigate the safety and efficacy of drotrecogin alfa (activated) in patients with severe sepsis after HSCT.

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Section: Discussionmentioning

confidence: 99%

Septic shock and multiple organ failure after hematopoietic stem cell transplantation: treatment with recombinant human activated protein C

Pastores

Papadopoulos

Brink

et al. 2002

Bone Marrow Transplant

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“…The Qd can be adjusted to as high as 6 L/h, thereby providing an enormous clearance potential with continuous therapy. This approach can be applied for as little as eight hours per day (or nocturnally) because the solute clearance is high and the ultrafiltration needs can frequently be realized in this short period (49,59). This hybrid dialytic intervention, named sustained or slow low efficiency dialysis (SLED), or extended daily dialysis (EDD), may soon become the "gold standard" for renal replacement therapy during acute renal failure.…”

Section: Continuous Venovenous Hemodialysis (Cvvhd or Cvvd)mentioning

confidence: 99%

“…It is widely accepted that the release of large amounts of pro-and anti-inflammatory mediators that occurs in severe sepsis contributes to the development of multiple organ dysfunction syndrome (MODS) (8,(58)(59)(60), including ARF. Theoretically, high-dose CRRT could remove mediators by convection and/or adsorption (44,61) and reduce mortality, even in the absence of ARF (62).…”

Section: Efficacy Of Crrt In Patients With Severe Sepsis or Septic Shockmentioning

confidence: 99%

Continuous Renal Replacement Therapies in Patients with Severe Sepsis and Septic Shock

García-Miguel¹

2012

Sepsis - An Ongoing and Significant Challenge

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“…In 1991, the American College of Chest Physicians (ACCP) and the Society of Critical Care Medicine (SCCM) used a new term 'Systemic Inflammatory Response Syndrome' (SIRS), which is more useful in clinical practice, and it requires at least two of the following criteria to be present: hyperthermia or hypothermia; tachypnea; tachycardia, and leukocytosis or leukopenia with immature neutrophils [3,4]. Thus, sepsis or SIRS represents the presence of infection associated with other general systemic signs and symptoms.…”

Section: Introductionmentioning

confidence: 99%

Complications of Sepsis in Infant. A Case Report

Meliţ

Mărginean

Georgescu

et al. 2016

The Journal of Critical Care Medicine

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Sepsis is a systemic inflammatory response (SIRS) characterized by two or more of the following: fever > 38.5 °C or <36 °C, tachycardia, medium respiratory frequency over two SD for age, increased number of leukocytes. The following is a case of an eight months old, female infant, admitted in to the clinic for fever (39.7 C), with an onset five days before the admission, following trauma to the inferior lip and gum. Other than the trauma to the lip and gum, a clinical exam did not reveal any other pathological results. The laboratory tests showed leukocytosis, positive acute phase reactants (ESR 105 mm/h, PCR 85 mg/dl), with positive blood culture for Staphylococcus aureus MSSA. at 24 hours. Three days from admission, despite the administration of antibiotics (Vancomycin+Meronem), there was no remission of fever, and the infant developed a fluctuant collection above the knee joint. This was drained, and was of a serous macroscopic nature. A decision was made to perform a CT, which confirmed the diagnosis of septic arthritis. At two days after the intervention, the fever reappeared, therefore the antibiotic regime were altered (Oxacillin instead of Vancomycin), resulting in resolution of the fever. Sepsis in infant is a complex pathology, with non-specific symptoms and unpredictable evolution.

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Sepsis: A New Hypothesis for Pathogenesis of the Disease Process

Cited by 837 publications

References 48 publications

Septic shock and multiple organ failure after hematopoietic stem cell transplantation: treatment with recombinant human activated protein C

Septic shock and multiple organ failure after hematopoietic stem cell transplantation: treatment with recombinant human activated protein C

Continuous Renal Replacement Therapies in Patients with Severe Sepsis and Septic Shock

Complications of Sepsis in Infant. A Case Report

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