Sepsis-3: new edition — old problems. analysis from the perspective of general pathology

Sepsis-3 Guidelines defines sepsis as an organ dysfunction caused by dysregulated host response to infection. To record organ dysfunction, the SOFA/quick SOFA scales were recommended. In fact, in medical practice, sepsis is considered nothing more than a critical infection that requires intensive ca...

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Main Authors: E. Yu. Gusev, N. V. Zotova, V. A. Chereshnev
Format: Article
Language:Russian
Published: Sankt-Peterburg : NIIÈM imeni Pastera 2021-09-01
Series:Infekciâ i Immunitet
Subjects:
Online Access:https://www.iimmun.ru/iimm/article/view/1629
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spelling doaj-d74b1ad829fb49a1a5293cf02a7954be2021-09-21T14:01:34ZrusSankt-Peterburg : NIIÈM imeni PasteraInfekciâ i Immunitet2220-76192313-73982021-09-0111464966210.15789/2220-7619-SAN-16291019Sepsis-3: new edition — old problems. analysis from the perspective of general pathologyE. Yu. Gusev0N. V. Zotova1V. A. Chereshnev2Institute of Immunology and Physiology of the Ural Branch of RASInstitute of Immunology and Physiology of the Ural Branch of RAS; Ural Federal University named after the first President of Russia B.N. YeltsinInstitute of Immunology and Physiology of the Ural Branch of RASSepsis-3 Guidelines defines sepsis as an organ dysfunction caused by dysregulated host response to infection. To record organ dysfunction, the SOFA/quick SOFA scales were recommended. In fact, in medical practice, sepsis is considered nothing more than a critical infection that requires intensive care. Therefore, sepsis is pathogenetically a nonhomogeneous condition manifested by diverse nosologies and syndromes. Unlike the previous two editions, Sepsis-1 and Sepsis-2 Guidelines, the formal criteria provided in the Sepsis-3 are closer to the de facto position, describe more specific, but less sensitive features to predict mortality. However, the initial, latent manifestations of critical conditions, which can be relatively effectively controlled by intensive therapy, remain outside the Sepsis-3 criteria. Not all signs of multiple organ dysfunctions (according to the Sepsis-3 criteria) will require intensive care. Hence, obviously the presence or absence of formal criteria of Sepsis-3 will not be always taken into account while verifying sepsis. The only relatively pathogenetically homogeneous definition in Sepsis-3 is “septic shock”. However, it also does not fully consider the staging (according to the degree of compensation of hemodynamic disturbances) and the phasing (according to the severity of the proinflammatory response) of the dynamics of the shock condition. From our point of view, a positive result of the Sepsis-3 consensus would be in transition of the systemic inflammatory response syndrome (SIRS) from the main to additional (optional) verifying sepsis criteria. We also believe that the weak side of the Sepsis-3 Guidelines is in underestimated mechanisms of systemic inflammation as a general pathological process in the genesis of developing critical conditions of various origins. From the perspective of general pathology, sepsis is a combination of the three common fundamental pathological processes: classical (canonical) and systemic inflammation (SI), as well as chronic systemic low-grade inflammation (parainflammation), the latter can be considered as an unfavorable background for development of the former two processes. All three processes are characterized by any SIR signs and require to be differentiated on the basis of integral criteria, which reflect specific blocks of the SI complex process. The pathogenesis of the SARS-CoV-2 infection (COVID-19) is a relevant example underlying inevitability of such approach. The systemic microvascular vasculitis, and its main clinical manifestations such as systemic microcirculatory disorders in the form of shockogenic conditions is the SI pathogenetic basis. Apparently, one of the modalities for further evolution of critical care medicine will be coupled to development of a more multilayered but effective methods for assessing pathogenesis of critical states and more differentiated methods of pathogenetic therapy. Therefore, it will require to modernize a number of fundamental premises in our knowledge about pathobiology, pathophysiology, and general pathology.https://www.iimmun.ru/iimm/article/view/1629sepsissystemic inflammatory reactionsystemic inflammationseptic shockmicrocirculationparainflammationcommon pathological processchronic low-grade inflammation
collection DOAJ
language Russian
format Article
sources DOAJ
author E. Yu. Gusev
N. V. Zotova
V. A. Chereshnev
spellingShingle E. Yu. Gusev
N. V. Zotova
V. A. Chereshnev
Sepsis-3: new edition — old problems. analysis from the perspective of general pathology
Infekciâ i Immunitet
sepsis
systemic inflammatory reaction
systemic inflammation
septic shock
microcirculation
parainflammation
common pathological process
chronic low-grade inflammation
author_facet E. Yu. Gusev
N. V. Zotova
V. A. Chereshnev
author_sort E. Yu. Gusev
title Sepsis-3: new edition — old problems. analysis from the perspective of general pathology
title_short Sepsis-3: new edition — old problems. analysis from the perspective of general pathology
title_full Sepsis-3: new edition — old problems. analysis from the perspective of general pathology
title_fullStr Sepsis-3: new edition — old problems. analysis from the perspective of general pathology
title_full_unstemmed Sepsis-3: new edition — old problems. analysis from the perspective of general pathology
title_sort sepsis-3: new edition — old problems. analysis from the perspective of general pathology
publisher Sankt-Peterburg : NIIÈM imeni Pastera
series Infekciâ i Immunitet
issn 2220-7619
2313-7398
publishDate 2021-09-01
description Sepsis-3 Guidelines defines sepsis as an organ dysfunction caused by dysregulated host response to infection. To record organ dysfunction, the SOFA/quick SOFA scales were recommended. In fact, in medical practice, sepsis is considered nothing more than a critical infection that requires intensive care. Therefore, sepsis is pathogenetically a nonhomogeneous condition manifested by diverse nosologies and syndromes. Unlike the previous two editions, Sepsis-1 and Sepsis-2 Guidelines, the formal criteria provided in the Sepsis-3 are closer to the de facto position, describe more specific, but less sensitive features to predict mortality. However, the initial, latent manifestations of critical conditions, which can be relatively effectively controlled by intensive therapy, remain outside the Sepsis-3 criteria. Not all signs of multiple organ dysfunctions (according to the Sepsis-3 criteria) will require intensive care. Hence, obviously the presence or absence of formal criteria of Sepsis-3 will not be always taken into account while verifying sepsis. The only relatively pathogenetically homogeneous definition in Sepsis-3 is “septic shock”. However, it also does not fully consider the staging (according to the degree of compensation of hemodynamic disturbances) and the phasing (according to the severity of the proinflammatory response) of the dynamics of the shock condition. From our point of view, a positive result of the Sepsis-3 consensus would be in transition of the systemic inflammatory response syndrome (SIRS) from the main to additional (optional) verifying sepsis criteria. We also believe that the weak side of the Sepsis-3 Guidelines is in underestimated mechanisms of systemic inflammation as a general pathological process in the genesis of developing critical conditions of various origins. From the perspective of general pathology, sepsis is a combination of the three common fundamental pathological processes: classical (canonical) and systemic inflammation (SI), as well as chronic systemic low-grade inflammation (parainflammation), the latter can be considered as an unfavorable background for development of the former two processes. All three processes are characterized by any SIR signs and require to be differentiated on the basis of integral criteria, which reflect specific blocks of the SI complex process. The pathogenesis of the SARS-CoV-2 infection (COVID-19) is a relevant example underlying inevitability of such approach. The systemic microvascular vasculitis, and its main clinical manifestations such as systemic microcirculatory disorders in the form of shockogenic conditions is the SI pathogenetic basis. Apparently, one of the modalities for further evolution of critical care medicine will be coupled to development of a more multilayered but effective methods for assessing pathogenesis of critical states and more differentiated methods of pathogenetic therapy. Therefore, it will require to modernize a number of fundamental premises in our knowledge about pathobiology, pathophysiology, and general pathology.
topic sepsis
systemic inflammatory reaction
systemic inflammation
septic shock
microcirculation
parainflammation
common pathological process
chronic low-grade inflammation
url https://www.iimmun.ru/iimm/article/view/1629
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