The role of systemic inflammation in the pathogenesis of hemorrhagic stroke in the presence or absence of effective brain blood flow

Bochkarev, P. Yu.; Berdyugina, O. V.; Zhidkova, V.S.; Зубова, Т. Э.; Gusev, E. Yu.

doi:10.17116/jnevro202012008224

Cited by 4 publications

(5 citation statements)

References 10 publications

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“…Complications of atherosclerosis of specific arteries can lead to the development of acute SI, as demonstrated in the clinic and through data on the pathogenesis of cardiogenic shock [284,[560][561][562][563]. Our studies have also shown that hemorrhagic stroke in elderly individuals complicated by severe coma and multiple organ failure is associated with the development of SI, including the phenomenon of paracoagulation (D-dimer > 500 ng/mL) [564]. In turn, we recorded the presence of chronic SI criteria, including paracoagulation, in patients with chronic limb-threatening ischemia caused by common femoral artery atherosclerotic lesions [66].…”

Section: Relation Of Atherosclerosis To Systemic Inflammation (Hyperi...supporting

confidence: 57%

Atherosclerosis and Inflammation: Insights from the Theory of General Pathological Processes

Gusev

Sarapultsev

2023

IJMS

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Recent advances have greatly improved our understanding of the molecular mechanisms behind atherosclerosis pathogenesis. However, there is still a need to systematize this data from a general pathology perspective, particularly with regard to atherogenesis patterns in the context of both canonical and non-classical inflammation types. In this review, we analyze various typical phenomena and outcomes of cellular pro-inflammatory stress in atherosclerosis, as well as the role of endothelial dysfunction in local and systemic manifestations of low-grade inflammation. We also present the features of immune mechanisms in the development of productive inflammation in stable and unstable plaques, along with their similarities and differences compared to canonical inflammation. There are numerous factors that act as inducers of the inflammatory process in atherosclerosis, including vascular endothelium aging, metabolic dysfunctions, autoimmune, and in some cases, infectious damage factors. Life-critical complications of atherosclerosis, such as cardiogenic shock and severe strokes, are associated with the development of acute systemic hyperinflammation. Additionally, critical atherosclerotic ischemia of the lower extremities induces paracoagulation and the development of chronic systemic inflammation. Conversely, sepsis, other critical conditions, and severe systemic chronic diseases contribute to atherogenesis. In summary, atherosclerosis can be characterized as an independent form of inflammation, sharing similarities but also having fundamental differences from low-grade inflammation and various variants of canonical inflammation (classic vasculitis).

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Section: Relation Of Atherosclerosis To Systemic Inflammation (Hyperi...supporting

confidence: 57%

Atherosclerosis and Inflammation: Insights from the Theory of General Pathological Processes

Gusev

Sarapultsev

2023

IJMS

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“…The main patterns of SI are evident in both sepsis and acute trauma. In addition, we previously showed the determining role of SI in hospital mortality in hemorrhagic strokes [ 16 ] and the development of refractory shock in massive obstetric hemorrhage [ 10 ]. The dynamics of acute SI is characterized by the phased pattern of the process depending on the duration, clinical presentation and severity of SIR ( Figure 7 ).…”

Section: Discussionmentioning

confidence: 99%

“…In separate studies, we tested procalcitonin as an additional criterion of the SI scale. We showed that procalcitonin can be employed to verify SI not only of septic but also aseptic nature [ 16 ]. The present study does not include procalcitonin because it was measured only in some patients in the above-mentioned groups, primarily to monitor the efficacy of antibiotic therapy.…”

Section: Introductionmentioning

confidence: 99%

Acute and Chronic Systemic Inflammation: Features and Differences in the Pathogenesis, and Integral Criteria for Verification and Differentiation

Zotova

Zhuravleva

Черешнев

et al. 2023

IJMS

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Currently, there is rationale for separating the systemic manifestations of classical inflammation from systemic inflammation (SI) itself as an independent form of the general pathological process underlying the pathogenesis of the most severe acute and chronic diseases. With this aim in view, we used integral scales of acute and chronic SI (ChSI), including the following blood plasma parameters: interleukins 6, 8, 10; tumor necrosis factor alpha; C-reactive protein; D-dimer; cortisol; troponin I; myoglobin. The presence of multiple organ dysfunction according to the SOFA score was also taken into account. The effectiveness of the scales was tested in groups of intensive care patients during different periods of acute trauma, sepsis, and septic shock. The ChSI scale was applicable under systemic autoimmune diseases, chronic purulent infections, chronic limb threatening ischemia, and end-stage renal disease of various genesis. The number of examined patients was 764 in total. The scales allowed us to verify specific phases of acute SI and identify pathogenetic risk factors of lethal outcomes, as well as the most severe variants of the chronic pathologies course. These scales are open adaptable systems (in terms of the nomenclature and choice of indicators). They are primarily intended for scientific research. However, the SI verification methodology presented in this paper may be useful for developing advanced criteria for assessing both the typical links in the pathogenesis of many diseases and the severity of the overall condition of patients for clinical practice.

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“…The fundamental difference between AFE and SS is that the transition from the phlogogenic stroke (cytokine storm) to the depressive phase (depletion phase) in SS takes days and weeks, and just hours in AFEs. Therefore, the dynamics of SI can be characterized by two principal variants based on the intensity of systemic alteration factors, namely, the “punching” variant (characteristic of sepsis) and the “breakthrough” variant (characteristic of AFE, very rare variants of lightning sepsis, and some variants of acute trauma) [ 9 , 21 ].…”

Section: Resultsmentioning

confidence: 99%

“…To verify and determine the specific phases of SI, we used the SI scale that had been previously tested in a study of acute infectious and aseptic critical states [ 9 , 13 , 20 , 21 ], and its derivative also studied in severe chronic diseases [ 13 , 20 , 22 ]. As the onset of a critical condition in the patients was sudden and required urgent resuscitation measures, the monitoring of the SI signs was performed already in an intensive therapy setting, including artificial lung ventilation (ALV), administration of vasopressors, and infusion therapy.…”

Section: Introductionmentioning

confidence: 99%

Shock-Associated Systemic Inflammation in Amniotic Fluid Embolism, Complicated by Clinical Death

et al. 2023

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Background: Amniotic fluid embolism (AFE) is one of the main causes of maternal mortality in developed countries. The most critical AFE variants may be considered from the perspective of systemic inflammation (SI), a general pathological process that includes high levels of systemic inflammatory response, neuroendocrine system distress, microthrombosis, and multiple organ dysfunction syndrome (MODS). This research work aimed to characterize the dynamics of super-acute SI using four clinical case studies of patients with critical AFE. Methods: In all the cases, we examined blood coagulation parameters, plasma levels of cortisol, troponin I, myoglobin, C-reactive protein, IL-6, IL-8, IL-10, and TNF-α, and calculated the integral scores. Results: All four patients revealed the characteristic signs of SI, including increased cytokine, myoglobin, and troponin I levels, changes in blood cortisol, and clinical manifestations of coagulopathy and MODS. At the same time, the cytokine plasma levels can be characterized not only as hypercytokinemia, and not even as a “cytokine storm”, but rather as a “cytokine catastrophe” (an increase of thousands and tens of thousands of times in proinflammatory cytokine levels). AFE pathogenesis involves rapid transition from the hyperergic shock phase, with its high levels of a systemic inflammatory response over to the hypoergic shock phase, characterized by the mismatch between low systemic inflammatory response values and the patient’s critical condition. In contrast to septic shock, in AFE there is a much more rapid succession of SI phases. Conclusion: AFE is one of the most compelling examples for studying the dynamics of super-acute SI.

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The role of systemic inflammation in the pathogenesis of hemorrhagic stroke in the presence or absence of effective brain blood flow

Cited by 4 publications

References 10 publications

Atherosclerosis and Inflammation: Insights from the Theory of General Pathological Processes

Atherosclerosis and Inflammation: Insights from the Theory of General Pathological Processes

Acute and Chronic Systemic Inflammation: Features and Differences in the Pathogenesis, and Integral Criteria for Verification and Differentiation

Shock-Associated Systemic Inflammation in Amniotic Fluid Embolism, Complicated by Clinical Death

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