Septic shock: clinical and morphological comparisons

A study of 45 protocols of pathoanatomical autopsies in 2010-2018 was conducted, in 32 of these protocols the diagnosis of sepsis was confirmed by microscopic examinations - metastatic purulent foci were found in the internal organs during pyemia and septicemia. The remaining 13 observations according to clinical and laboratory data allowed to designate as infectious-toxic shock. According to the criteria of septic shock proposed by the international consensus group «Sepsis-3» 2016, for clinical and morphological comparisons, 8 autopsies with a clinical diagnosis of septic shock were selected, 24 with sepsis without shock and 13 with infectious and toxic shock. Retrospective histological studies of archival microscopic preparations of the brain, heart and kidneys were performed. In the observations dated 2017 and 2018 were used additional histological and histochemical technologies, microphotography with a scanning microscope. Histological signs of microcirculatory disorders were divided into five types - leukostasis, sludge-phenomenon, descending of the endothelium, thrombosis, diapedemic hemorrhages. In the preparations of myocardium, liver and kidneys, using additional techniques, foci of dismetabolic necrosis were revealed, which objectively indicated morphogenesis of insolvency of these organs. The study expanded the understanding of the morphological microcirculatory equivalents of septic shock, which clinically formed the basis of the syndrome - the body’s hyper-allergic response to the hematogenous generalization of infection with severe hemodynamic disorders, microcirculation, and severe metabolic disorders.

sepsis, septic shock, morphology, histology, microcirculation, leukostasis, sludge, endovascular, thrombus, hemorrhage