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Nat Rev Dis Primers. 2016 Jun 30;2:16045. doi: 10.1038/nrdp.2016.45.

Sepsis and septic shock.

Author information

1
Department of Anesthesiology, Washington University of St. Louis, St. Louis, Missouri, USA.
2
Department of Surgery, University of Florida College of Medicine, Shands Hospital, Room 6116, 1600 SW Archer Road, Gainesville, Florida 32610-0019, USA.
3
Department of Infectious Diseases and Medicine, Alpert Medical School of Brown University, Providence, Rhode Island, USA.
4
Department of Anesthesiology and Intensive Care, Jena University Hospital, Jena, Germany.
5
Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium.

Abstract

For more than two decades, sepsis was defined as a microbial infection that produces fever (or hypothermia), tachycardia, tachypnoea and blood leukocyte changes. Sepsis is now increasingly being considered a dysregulated systemic inflammatory and immune response to microbial invasion that produces organ injury for which mortality rates are declining to 15-25%. Septic shock remains defined as sepsis with hyperlactataemia and concurrent hypotension requiring vasopressor therapy, with in-hospital mortality rates approaching 30-50%. With earlier recognition and more compliance to best practices, sepsis has become less of an immediate life-threatening disorder and more of a long-term chronic critical illness, often associated with prolonged inflammation, immune suppression, organ injury and lean tissue wasting. Furthermore, patients who survive sepsis have continuing risk of mortality after discharge, as well as long-term cognitive and functional deficits. Earlier recognition and improved implementation of best practices have reduced in-hospital mortality, but results from the use of immunomodulatory agents to date have been disappointing. Similarly, no biomarker can definitely diagnose sepsis or predict its clinical outcome. Because of its complexity, improvements in sepsis outcomes are likely to continue to be slow and incremental.

PMID:
28117397
PMCID:
PMC5538252
DOI:
10.1038/nrdp.2016.45
[Indexed for MEDLINE]
Free PMC Article

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