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Nonspecific Removal of Sepsis Mediators

  • Chapter
Sepsis

Sepsis is a growing clinical problem in our society, with an estimated annual incidence rate of above 300 cases per 100,000 people and mortality that exceeds 30% in those individuals suffering the disease (Esteban et al. 2007; Angus et al. 2001). Despite apparent recent successes in the treatment (Bernard et al. 2001), sepsis morbidity and mortality remain very high. This implies that new efforts are needed to translate to the clinical practice the huge information that preclinical research has generated in the past decade about the mechanisms of sepsis.

One of the problems is that sepsis entails multiple disorders in different organs and systems, the individual contribution of each one, or the dominance of a particular one, in the disease process being unclear. Initially, sepsis was considered a disorder due to an uncontrolled inflammatory response (Hotchkiss and Karl 2003). However, clinical interventions directed to the inflammatory elements did not reduce morbidity and mortality associated with the disease (Hotchkiss and Karl 2003). Since inflammation and coagulation are tightly linked, and sepsis-associated coagulopathy is almost universal in patients with severe sepsis, antithrombotic-targeted therapy has been clinically investigated with an apparent success, though controversial and limited (Costa et al. 2007; Nadel et al. 2007). Recent data also suggests that most deaths from sepsis are due to an extensive death of immune mediator cells (Hotchkiss and Nicholson 2006). Therefore, in 15 years we have moved from immunostimulation to immunosuppression as cause of sepsis, with one stop in coagulation disorders.

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Authors and Affiliations

  1. Critical Care Department, Hospital Universitari de Bellvitge Feixa Llarga s/n 08907 – Hospitalet de Llobregat (Barcelona), Spain

    Xosé Luis Pérez-Fernandez & Joan Sabater Riera

  2. Critical Care Departmen, Bellvitge University Hospital Feixa Llarga s/n 08907 – Hospitalet de Llobregat (Barcelona), Spain

    Rafael Mañez

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  1. Xosé Luis Pérez-Fernandez
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  2. Joan Sabater Riera
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  3. Rafael Mañez
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Editors and Affiliations

  1. Critical Care Department – Joan XXIII University Hospital, Universidad Rovira & Virgili and Institut Pere Virgili CIBER Enfermedades Respiratorias, Doctor Mallafre Guasch, 4, 43007, Tarragona, Spain

    Jordi Rello MD, PhD

  2. Division Pulmonary and Critical Care Medicine, San Antonio, TX, 78229-4404, USA

    Marcos I. Restrepo MD, MSc

  3. Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA

    Marcos I. Restrepo MD, MSc

  4. South Texas Veterans Health Care System Audie L. Murphy Division, Veterans Evidence-Based Research Dissemination Implementation Center (VERDICT), 7400 Merton Minter Blvd (11C6), San Antonio, TX, 78229-4404, USA

    Marcos I. Restrepo MD, MSc

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Pérez-Fernandez, X.L., Riera, J.S., Mañez, R. (2008). Nonspecific Removal of Sepsis Mediators. In: Rello, J., Restrepo, M.I. (eds) Sepsis. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-540-79001-3_6

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