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Endorganschäden bei Entzündung und Sepsis

  • Schwerpunkt: Endorganschäden
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Zusammenfassung

Entzündliche Komponenten sind Bestandteil der Pathogenese infektiöser, aber auch nichtinfektiöser Erkrankungen. Es ist eine der wesentlichen neueren pathogenetischen Erkenntnisse der letzten Dekaden, dass eine Aktivierung der natürlichen Immunabwehr auch ohne infektiöses Agens bei zahlreichen physiologischen und pathophysiologischen Prozessen erfolgt. Allein körperliche oder psychische Belastung kann eine Entzündungsreaktion auslösen. Über die molekularen Mechanismen der zellulären und Organdysfunktionen durch die Aktivierung von Mediatoren mit inflammatorischem Potenzial gibt es in den letzten Dekaden einen erheblichen Wissenszuwachs. Validierte Scoresysteme erlauben eine präzise Erfassung und Quantifizierung der Organdysfunktionen bei Entzündung und Sepsis. Dagegen fußt die Therapie der Endorganschäden bei schweren septischen und nichtseptischen Entzündungsprozessen auch heute noch überwiegend auf supportiven Therapiemaßnahmen.

Abstract

Inflammatory components form part of the pathogenesis of infectious, but also non-infectious diseases. One of the most important revelations of the last decades was the finding of an activation of the natural immune response in numerous physiological and pathophysiological processes despite the absence of an infectious agent. Even physical exercise or psychical stress may evoke an inflammatory response. Substantial insight has been gained in the recent decades into the molecular mechanisms of cellular and organ dysfunction by the impact of mediators with inflammatory potential. Validated score systems allow a precise detection and quantification of organ dysfunctions in inflammation and sepsis. In contrast therapy of organ damage in severe septic and non-septic inflammatory processes presently is mainly still based on supportive therapeutic measures.

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Literatur

  1. Annane D, Sebille V, Charpentier C et al. (2002) Effect of treatment with low doses of hydrocortisone and fludrocortisone on mortality in patients with septic shock. JAMA 288: 862–871

    CAS  PubMed  Google Scholar 

  2. Baud V, Karin M (2001) Signal transduction by tumor necrosis factor and its relatives. Trends Cell Biology 11: 372–377

    Article  CAS  Google Scholar 

  3. Benschop RJ, Jacobs R, Sommer B, Schürmeyer TH, Raab HR, Schmidt RE, Schedlowski M (1996) Modulation of the immunologic response to acute stress in humans by β-blockade or benzodiazepines. FASEB J 10: 517–524

    CAS  PubMed  Google Scholar 

  4. Blunck R, Scheel O, Müller M, Brandenburg K, Seitzer U, Seydel U (2001) New insights into endotoxin-induced activation of macrophages: involvement of a K+ channel in transmembrane signaling. J Immunol 166: 1009–1015

    CAS  PubMed  Google Scholar 

  5. Bone RC (1996) Sir Isaak Newton, sepsis, SIRS, and CARS. Crit Care Med 24: 1125–1128

    Google Scholar 

  6. Cohen J (2002) The immunopathogenesis of sepsis. Nature 420: 885–891

    Article  CAS  PubMed  Google Scholar 

  7. Godin PJ, Buchmann TG (1996) Uncoupling of biological oscillators: A complementary hypothesis concerning the pathogenesis of multiple organ dysfunction syndrome. Crit Care Med 24: 1107–1116

    CAS  PubMed  Google Scholar 

  8. Godin PJ, Fleisher LA, Eidsath A et al. (1996) Experimental human endotoxemia increases cardiac regularity: results from a prospective, randomized crossover trial. Crit Care Med 24: 1117–1124

    CAS  PubMed  Google Scholar 

  9. Heinroth KM, Kuhn C, Stache N, Witthaut R, Müller-Werdan U, Werdan K, Prondzinsky R (1999) Eingeschränkte Herzfrequenzvariabilität bei Patienten mit septischem und nichtseptischem Multi-Organ-Dysfunktions-Syndrom. Intensivmedizin 36: 436–445

    Article  Google Scholar 

  10. Hotchkiss RS, Karl IE (2003) The pathophysiology and treatment of sepsis. N Engl J Med 348: 138–150

    Article  CAS  PubMed  Google Scholar 

  11. Le Gall JR, Lemeshow S, Saulnier F (1993) A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter study. JAMA 270: 2957–2963

    PubMed  Google Scholar 

  12. Lien E, Ingalls RR (2002) Toll-like receptors. Crit Care Med 30 (Suppl): S1–S11

    CAS  Google Scholar 

  13. Loppnow H (2001) Zytokine: Klassifikation, Rezeptoren, Wirkungsmechanismen. Internist 42: 13–27

    Article  CAS  Google Scholar 

  14. Mann DL, Deswal A, Bozkurt B, Torre-Amione G (2002) New therapeutics for chronic heart failure. Annu Rev Med 53: 59–74

    Article  CAS  PubMed  Google Scholar 

  15. Members of the American College of Chest Physician, Society of Critical Care Medicine Consensus Conference Committee (1992) American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference: Definition for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Crit Care Med 20: 864–874

    PubMed  Google Scholar 

  16. Müller-Werdan U, Engelmann H, Werdan K (1998) Cardiodepression by tumor necrosis factor α. Eur Cytokine Netw 9: 689–691

    PubMed  Google Scholar 

  17. Müller-Werdan U, Werdan K (2000) Immune modulation by catecholamines—a potential mechanism of cytokine release in heart failure? Herz 25: 271–273

    Google Scholar 

  18. Müller-Werdan U, Werdan K (1999) Septic cardiomyopathy. Curr Opin Crit Care 5: 415–420

    Article  Google Scholar 

  19. Müller-Werdan U, Werdan K (2003) Prophylaxe und Therapie der akuten septischen Kardiomyopathie. In: Werdan K, Schuster HP, Müller-Werdan U (Hrsg) Intensivtherapie bei Sepsis und Multiorganversagen, 4. Aufl. Springer, Heidelberg New York Tokio, (im Druck)

  20. Ostrowski K, Rohde T, Zacho M, Asp S, Pedersen BK (1998) Evidence that interleukin-6 is produced in human skeletal muscle during prolonged running. J Physiol 508: 949–953

    CAS  PubMed  Google Scholar 

  21. Peres Bota D, Melot C, Lopes Ferreira F, Nuygen Ba V, Vincent JL (2002) The Multiple Organ Dysfunction Score (MODS) versus the Sequential Organ Failure Assessment (SOFA) score in outcome prediction. Intensive Care Med 28: 1619–1624

    Article  Google Scholar 

  22. Pilz G, Appel R, Kreuzer E, Werdan K (1997) Comparison of early IgM-enriched immunglobulin vs polyvalent IgG administration in score-identified post-cardiac surgical patients at high risk for sepsis. Chest 111: 419–426

    CAS  PubMed  Google Scholar 

  23. Pilz G, Werdan K (1990) Cardiovascular parameters and scoring systems in the evaluation of response to therapy in sepsis and septic shock. Infection 18: 253–262

    CAS  PubMed  Google Scholar 

  24. Poltorak A, He X, Smirnova I et al. (1998) Defective LPS signaling in C3H/HeJ and C57BL/10ScCr mice: mutations in Tlr4 gene. Science 282: 2085–2088

    Article  CAS  PubMed  Google Scholar 

  25. Power C, Fanning N, Redmond HP (2002) Cellular apoptosis and organ injury in sepsis: a review. Shock 18: 197–211

    PubMed  Google Scholar 

  26. Rauchhaus M, Müller-Werdan U (2001) Zytokine bei Herzerkrankungen. Internist 42: 75–84

    Article  CAS  Google Scholar 

  27. Rauchhaus M, Schmidt HB, Doehner W et al. (2000) Changes in metabolic and cytokine kinetics during strenuous exercise in patients with chronic heart failure. Eur J Heart Failure 2 (Suppl 2): 67

    Article  Google Scholar 

  28. Read RC, Wyllie DH (2001) Toll receptors and sepsis. Curr Opin Crit Care 7: 371–375

    CAS  PubMed  Google Scholar 

  29. Rivers E, Nguyen B, Havstad S et al. (2001) Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med 345: 1368–1377

    PubMed  Google Scholar 

  30. Schmidt HB, Werdan K, Müller-Werdan U (2001) Autonomic dysfunction in the ICU patient. Curr Opin Crit Care 7: 314–322

    Article  CAS  PubMed  Google Scholar 

  31. Vincent JL, Moreno R, Takala J et al. on behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine (1996) The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. Intensive Care Med 22: 707–710

    Article  PubMed  Google Scholar 

  32. Werdan K (2002) Grundlagen der Notfall- und Intensivtherapie. In: Wolff Weihrauch (Hrsg) Internistische Therapie 2002/2003, 14. Aufl. Urban & Fischer, München Jena

  33. Winchell RJ, Hoydt DB (1997) Analysis of heart-rate-variability: a noninvasive predictor of death and poor outcome in patients with severe head injury. J Trauma 43: 927–933

    CAS  PubMed  Google Scholar 

  34. Witthaut R, Werdan K, Schuster HP (1998) Multiorgandysfunktions-Syndrom und Multiorganversagen—Diagnose, Prognose und Therapiekonzepte. Internist 39: 493–501

    Google Scholar 

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Authors and Affiliations

  1. Universitätsklinik und Poliklinik für Innere Medizin III, Universität Halle-Wittenberg

    U. Müller-Werdan & K. Werdan

  2. Universitätsklinik und Poliklinik für Innere Medizin III, Universität Halle-Wittenberg, Ernst-Grube-Straße 40, 06097, Halle

    U. Müller-Werdan

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Correspondence to U. Müller-Werdan.

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Müller-Werdan, U., Werdan, K. Endorganschäden bei Entzündung und Sepsis. Internist 44, 864–872 (2003). https://doi.org/10.1007/s00108-003-0956-y

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