Actual aspects of sepsis and septic shock


Cite item

Full Text

Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription or Fee Access

Abstract

He review presents an analysis of up-to-date views on sepsis and septic shock. Results of consenting conferences are given with classification of sepsis in adults and children. Mortality indexes are presented in patients’ group with sepsis. Basic pathogenesis links are examined i.e. bacteriemia, microbe toxemia, endo(auto)toxicosis, systemic destructive vasculitis, growing hypercoagulation transforming into coagulopathia, consumption trombocytopenia with trombohemorrhagic syndrome and severe immunesuppression. Pathogenesis of septic shock is divided into processes developing in various organs and tissues as well as into intracellular ones: such as oxidative stress and mitochondrial insufficiency. The role of pathogen-associated molecular images - patterns is portrayed in the development of generalized acyclic infection process. A scheme of up-to-date septic shock therapy is presented. An important role of nitrogen oxide in the development of stabile hypotonia resistant to vasopressin therapy is proven. The potency of nitrogen oxide to produce free-radical peroxinitrite inducing lipids peroxide oxidation in membranes is reflected. Its ability to react with non-hem iron- and zink- containing proteins is mentioned. Key factors contributing to activation of genes responsible for inducible nitrogen oxide synthase operation are revealed. Extremely severe sepsis and septic shock are believed to be the most serious problem of contemporary medicine thus necessitating to produce new medicines affecting the most drug-resistant links of its pathogenesis. In many a countries trials are continuing to introduce new medicines like nitrogen oxide synthase inhibitors for the treatment of patients with septic shock.

Full Text

Restricted Access

About the authors

Danila Viktorovich Strukov

State Pediatric Medical University

Email: dstrukov@yandex.ru
Postgraduate Student Pathophisiologу Department

Yuriy Stanislavovich Alexandrovich

State Pediatric Medical University

Email: jalex1963@mail.ru
MD, PhD, Dr Med Sci, Head, Dept. of Aneasthesiolgic and reanimatologic

Andrey Glebovich Vasiliev

State Pediatric Medical University

Email: avas7@mail.ru
MD, PhD, Dr Med Sci, Head, Dept. of Pathophysiology

References

  1. Васильев А. Г., Чурилов Л. П. Иммунология и иммунопатология. Руководство по иммунологии и иммунопатологии. - Санкт-Петербург: Сотис, 2006. - 180 с.
  2. Жданов Г. Г., Зильбер А. П. Реанимация и интенсивная терапия М.: Издательский центр «Академия» 2007. - 400 с.
  3. Козлов В. К. Сепсис. Этиология, иммунопатогенез, концепция современной иммунотерапии. - СПб.: Диалект, 2006. - 304 с.
  4. Колесникова Л. И., Долгих В. В. Ген эндотелиальной синтазы окиси азота и эссенциальная артериальная гипертензия у подростков разных этнических групп, проживающих на территории республики Бурятия // БЮЛЛЕТЕНЬ СО РАМН. - 2009. - № 6. - С. 109.
  5. Корячкин В. А., Страшнов В. И. Интенсивная терапия угрожающих состояний. - Санкт-Петербургское медицинское издательство, 2002. - 288 с.
  6. Малышев В. Д. Кислотно-основное состояние и водно-электролитный баланс в интенсивной терапии М.: «Медицина» 2005. - 228 с.
  7. Метельская В. А., Гуманова Н. Г. Оксид азота: роль в регуляции биологических функций, методы определения в крови человека // Лабораторная медицина. - 2005. - № 7. - С. 20.
  8. Николаев А. Я. Биологическая химия. - М.: МИА, 2004. - 566 с.
  9. Одыванова Л. Р., Сосунов А. А., Гатчев Я., Цервос-Наварро Д. Успехи соврем, биологии. - 1997. - Т. 117. - С. 374-389.
  10. Петренко Ю. Окись азота и судьба человека // Наука и жизнь. - 2001. - № 7. - С. 40-43.
  11. Саенко В. Ф., Десятерик В. И., Перцева Т. А., Шаповалюк В. В. Сепсис и полиорганная недостаточность. Кривой Рог: «Минерал», 2005. - 466 с.
  12. Сомова Л. М., Плехова Н. Г. Оксид азота как медиатор воспаления // Вестник ДВО РАН. - 2006. - № 2. - С. 77-80.
  13. Таганович А. Д., Кухта В. К., Морозкина Т. С. и др. Биологическая химия. Краткий курс лекций. - Минск: БГМУ, 2005. - 119 с.
  14. Тарасенко С. В., Дмитриева Н. В., Матвеева С. А. Шок. Патогенез, диагностика, лечение. Рязань РИО РГМУ, 2005. - 67 с.
  15. Цыган Н. В., Одинак М. М., Пелешок А. С., Марченко С. П., Наумов А.Б., Трашков А. П., Васильев А. Г., Хубулава Г. Г., Леванович В. В. Нейропротекция при реконструктивных операциях на дуге аорты // Вестник Российской военно-медицинской академии. - 2012. - № 2. - С. 119-127.
  16. Adamson G. M., Billings R. E. Toxicol Appl. // Pharmacol. - 1993. - Vol. 119. - P. 100-107.
  17. Akram M. Citric Acid cycle and role of its intermediates in metabolism. // Cell Biochem Biophys. - 2014. - Vol. 68, N 3. - P. 475-478.
  18. Angus D. C., Linde-Zwirble W. T., Lidicker J., Clermont G., Carcillo J. et al. Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. // Crit. Care Med. - 2001. - Vol. 29. - P. 1303-1310.
  19. Arriagada S. D., Díaz R. F., Donoso F. A., Cruces R. P. PIRO classification in pediatric severe sepsis and septic shock: a new model for staging and its potential usefulness in prognoses // Rev. Chilena Infectol. - 2010 Feb. - Vol. 27 (1). - P. 17-23.
  20. Cauwels A., Bultinck J., De Zwaef R., Vandendriessche B., Magez S., Brouckaert P. Nitric oxide production by endotoxin preparations in TLR4-deficient mice // Nitric Oxide. - 2014. - Vol. 30, N 36. - P. 36-43.
  21. Chan J. K., Roth J., Oppenheim J. J. et al. Alarmins: awaiting a clinical response // J. Clin. Invest. - 2012. - Vol. 122. - P. 2711-2719.
  22. Chen J. Q., Russo J. Dysregulation of glucose transport, glycolysis, TCA cycle and glutaminolysis by oncogenes and tumor suppressors in cancer cells // Biochim. Biophys Acta. - 2012. - Vol. 1826, N 2. - P. 370-384.
  23. Czupryna P., Garkowski A., Moniuszko A., Pancewicz S., Ciemerych A., Zajkowska J. Patients with sepsis in infectious diseases department in years 1997-2010 epidemiology and clinical features // Przegl. Epidemiol. - 2013. - Vol. 67, N 3. - P. 429-434, p. 535-538.
  24. de Jong H. K., van der Poll T., Wiersinga W. J. The systemic pro-inflammatory response in sepsis // J. Innate Immun. - 2010. - Vol. 2. - P. 422-430.
  25. Derek C., Angus M. D., Tom van der Poll M. D., Ph. D. Severe Sepsis and Septic Shock. // N. Engl. J. Med. - 2013. - Vol. 369. - P. 840-851.
  26. Eisenreich W., Heesemann J., Rudel T., Goebel W. Metabolic host responses to infection by intracellular bacterial pathogens. // Front Cell Infect Microbiol. - 2013. - Vol. 9, N 3. - P. 18-24.
  27. Fast D. J., Lynch R. C., Leu R. W. // J. Interferon Res. - 1993. - Vol. 13. - P. 271-278.
  28. Forstermann U., Closs E. I., Pollock J. S., Nakane M., Schwarz P., Gath I., Kleinert H. // Hypertension. - 1994. - Vol. 23. - P. 1121-1131.
  29. Galley H. F. Oxidative stress and mitochondrial dysfunction in sepsis. // Br. J. Anaesth. - 2011. - Vol. 107. - P. 57-64.
  30. Goldenberg N. M., Steinberg B. E., Slutsky A. S., Lee W. L. Broken barriers: a new take on sepsis pathogenesis. // Sci. Transl. Med. - 2011. - Vol. 3. - P. 88-105.
  31. Grädler U., Fuchss T., Ulrich W. R., Boer R., Strub A., Hesslinger C., Anézo C., Diederichs K., Zaliani A. Novel nanomolar imidazo [4,5-b]pyridines as selective nitric oxide synthase (iNOS) inhibitors: SAR and structural insights // Bioorg. Med. Chem. Lett. - 2011. - Vol. 15; 21, N 14. - P. 4228-4232.
  32. Gray L. R. Tompkins S. C., Taylor E. B. Regulation of pyruvate metabolism and human disease // Cell Mol. Life Sci. - 2013. - Vol. 21. - P. 2-21.
  33. Kandasamy K., Prawez S., Choudhury S., More A. S., Ahanger A. A., Singh T. U., Parida S., Mishra S. K. Atorvastatin prevents vascular hyporeactivity to norepinephrine in sepsis: role of nitric oxide and α-adrenoceptor mRNA expression. // Shock. - 2011. - Vol. 36, № 1. - P. 76-82.
  34. Lei H., Luo S., Qin H., Xia Y. Molecular Mechanisms of Endothelial NO Synthase Uncoupling // Curr. Pharm. Des. - 2013. - Vol. 29. - P. 1200-1248.
  35. Levi M., van der Poll T. Inflammation and coagulation // Crit. Care Med. - 2010. - Vol. 38, 2 Suppl. - P. S26-34.
  36. Levy M. M., Fink M. P., Marshall J. C., Abraham E., Angus D., Cook D., Cohen J., Opal S. M., Vincent J. L., Ramsay G. International Sepsis Definitions Conference // Intensive Care Med. - 2003. - Vol. 29, N 4. - P. 530-538.
  37. Lorente L., Martín M. M., López-Gallardo E., Iceta R., Solé-Violán J., Blanquer J., Labarta L., Díaz C., Jiménez A., Lafuente N., Hernández M., Méndez F., Medina N., Ferrer-Agüero J. M., Ferreres J., LLimiñana M. C., Mora M. L., Lubillo S., Sánchez-Palacios M., Montoya J., Ruiz-Pesini E. Platelet cytochrome c oxidase activity and quantity in septic patients // Crit. Care Med. - 2011. - Vol. 39, N 6. - P. 1289-1294.
  38. Madonna R., Jiang J., Geng Y. J. Attenuated expression of gelsolin in association with induction of aquaporin-1 and nitric oxide synthase in dysfunctional hearts of aging mice exposed to endotoxin // Int. J. Immunopathol Pharmacol. - 2012. - Vol. 25, N 4. - P. 911-922.
  39. McCabe W.R., Treadwell T.L., De Maria A. Jr. Pathophysiology of bacteremia // Am. J. Med. - 1983. Vol. 28, N 75. - P. 7-18.
  40. Moncada S., Palmer R. M. J., Higgs E. A. // Pharmacol. Rev. - 1991. - Vol. 43. - P. 109-142.
  41. Morel J., Li J. Y., Eyenga P., Meiller A., Gustin M. P., Bricca G., Molliex S., Viale J. P. Early adverse changes in liver microvascular circulation during experimental septic shock are not linked to an absolute nitric oxide deficit // Microvasc. Res. - 2013. - Vol. 90. - P. 187-191.
  42. Nunes-Nesi A., Araújo W. L., Obata T., Fernie A. R. Regulation of the mitochondrial tricarboxylic acid cycle // Curr. Opin. Plant Biol. - 2013. - Vol. 16, N 3. - P. 335-343.
  43. Palmer R. M. J., Ferrige A. G., Moncada S. // Nature. - 1987. - Vol. 327. - P. 524-526.
  44. Radi R., Beckman J. S., Bush K. M., Freeman B. A. // J. Biol. Chem. - 1991. - Vol. 266. - P. 4244-4250.
  45. Rochette L., Lorin J., Zeller M., Guilland J. C., Lorgis L., Cottin Y., Vergely C. Nitric oxide synthase inhibition and oxidative stress in cardiovascular diseases: possible therapeutic targets? // Pharmacol. Ther. - 2013. - Vol. 140, N 3. - P. 239-257.
  46. Ronco C. Lipopolysaccharide (LPS) from the cellular wall of Gram-negative bacteria, also known as endotoxin, is a key molecule in the pathogenesis of sepsis and septic shock. Preface // Blood Purif. - 2014. - Vol. 37, Suppl. 1. - P. 12-15.
  47. Rosselet A., Feihl F., Markert M., Gnaegi A., Perret C., L. Liaudet. Selective iNOS inhibition is superior to norepinephrine in the treatment of rat endotoxic shock // Am. J. Respir. Crit. Care Med. - 1998. - Vol. 157, N 1. - P. 162-170.
  48. Salomao R., Brunialti M. K., Rapozo M. M., Baggio-Zappia G. L., Galanos C. et al. Bacterial sensing, cell signaling, and modulation of the immune response during sepsis // Shock. - 2012. - Vol. 38, N 3. - P. 227-242.
  49. Scand J. Severe sepsis and septic shock: defining the clinical problem // Infect. Dis. - 2003. - Vol. 35, N 9. - P 529-534.
  50. Searle N. R., Sahab P. // Can. J. Anaesth. - 1992. - Vol. 39, N 21. - P. 838-857.
  51. Takeuchi O., Akira S. Pattern recognition receptors and inflammation // Cell. - 2010. - Vol. 1, N 4. - P. 805-820.
  52. Van der Poli T. Immunotherapy of sepsis // Lancet Infect Dis. - 2001. - Vol. 1, N 1. - P. 165-74.
  53. Wang H. E., Szychowski J. M., Griffin R., Safford M. M., Shapiro N. I., Howard G. Long-term mortality after community-acquired sepsis: a longitudinal population-based cohort study // BMJ Open. - 2014. - Vol. 17, N 4,1. - P. 121-26.
  54. Wang L., Taneja R., Razavi H.M., Law C., Gillis C., Mehta S. Specific role of neutrophil inducible nitric oxide synthase in murine sepsis-induced lung injury in vivo // Shock. - 2012. - Vol. 37, N 5. - P. 539-547.
  55. Xu C., Yi C., Wang H., Bruce I. C., Xia Q. Mitochondrial nitric oxide synthase participates in septic shock myocardial depression by nitric oxide overproduction and mitochondrial permeability transition pore opening // Shock. - 2012. - Vol. 37, N 1. - P. 110-115.
  56. Yan J., Li S., Li S. The Role of the Liver in Sepsis // Int. Rev. Immunol. - 2014. - Vol. 10. - P. 34-41.
  57. Zhou H. Y., Yuan Z., Du Y. P. Prior use of four invasive procedures increases the risk of Acinetobacter baumannii nosocomial bacteremia among patients in intensive care units: a systematic review and meta-analysis. // Int. J. Infect. Dis. - 2014. - Vol. 4. - P. 21-26.

Supplementary files

Supplementary Files
Action
1. JATS XML
Download

Copyright (c) 2014 Strukov D.V., Alexandrovich Y.S., Vasiliev A.G.

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.
СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).
Регистрационный номер и дата принятия решения о регистрации СМИ: серия ПИ № ФС 77 - 69634 от 15.03.2021 г.


This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies