SOFA Score, Hemodynamics and Body Temperature Allow Early Discrimination between Porcine Peritonitis-Induced Sepsis and Peritonitis-Induced Septic Shock

Abstract

Porcine model of peritonitis-induced sepsis is a well-established clinically relevant model of human disease. Interindividual variability of the response often complicates the interpretation of findings. To better understand the biological basis of the disease variability, the progression of the disease was compared between animals with sepsis and septic shock. Peritonitis was induced by inoculation of autologous feces in fifteen anesthetized, mechanically ventilated and surgically instrumented pigs and continued for 24 h. Cardiovascular and biochemical parameters were collected at baseline (just before peritonitis induction), 12 h, 18 h and 24 h (end of the experiment) after induction of peritonitis. Analysis of multiple parameters revealed the earliest significant differences between sepsis and septic shock groups in the sequential organ failure assessment (SOFA) score, systemic vascular resistance, partial pressure of oxygen in mixed venous blood and body temperature. Other significant functional differences developed later in the course of the disease. The data indicate that SOFA score, hemodynamical parameters and body temperature discriminate early between sepsis and septic shock in a clinically relevant porcine model. Early pronounced alterations of these parameters may herald a progression of the disease toward irreversible septic shock.

Modeling sepsis, with a special focus on large animal models of porcine peritonitis and bacteremia

“…Unfortunately, to the best of our knowledge, there are no clearly defined large animal model of sepsis phenotypes, in which to explore underlying pathophysiology or to test novel therapeutic targets. Nevertheless, we have recently demonstrated the associations of outcome with clinically relevant phenotypes ( Al-Obeidallah et al, 2021 ). In that study, SOFA score, hemodynamical parameters and body temperature were shown to significantly and early discriminate between sepsis and septic shock in a clinically relevant porcine model.…”

“…A standard experimental setting may include: a central venous catheter for drug and fluid infusion (inserted through the left jugular vein); a balloon-tipped thermodilution pulmonary artery catheter (placed via the right jugular vein); a femoral arterial catheter for blood pressure recording and blood sampling; a fiberoptic catheter for thermal-dye double-indicator dilution measurements; ultrasound transit time flow probes (e.g., around the portal vein, the common hepatic artery, and the left renal artery); catheters in the portal, renal, and hepatic veins; laser Doppler flowmetry for monitoring ileal mucosal and renal cortex microcirculation; and a cystostomy catheter for urine collection (percutaneous insertion under ultrasound guidance). In case hemofiltration techniques are investigated, a dialysis catheter (e.g., 14-French double-lumen) may be inserted into the right femoral vein and serve for hemofiltration access (Stengl et al, 2010b;Jarkovska et al, 2016;Jarkovska et al, 2018;Al-Obeidallah et al, 2021). Such extensive monitoring allows for a determination of the modified SOFA score according to the Third International Consensus definitions of Frontiers in Physiology frontiersin.org sepsis and septic shock (Singer et al, 2016) with the exclusion of the Glasgow coma scale-based neurologic component due to the use of general anesthesia.…”

“…Peritonitis can be induced by inoculating autologous feces (0.5–2 g·kg-1, suspended in 200 mL saline) into the abdominal cavity through drainage tubes placed through the abdominal wall ( Jarkovska et al, 2016 ). In our experimental setting, inoculation of high doses of feces (>1 g·kg-1) is usually necessary for reaching the septic shock stage within 24 h. On the other hand, inoculation of low doses of feces (0.5 g·kg-1) usually only results into development of sepsis but not septic shock ( Al-Obeidallah et al, 2021 ). In peritonitis model, a significant variability in the host response is often encountered.…”