ObjectiveTo summarize the mechanism of hydrogen sulfide (H2S) in regulating autophagy and ameliorating multi-organ dysfunction in the treatment of sepsis.MethodThe relevant literatures at home and abroad in recent years were systematically searched and read to review the mechanism of H2S in regulating autophagy and ameliorating multi-organ dysfunction during sepsis.ResultsAs a new medical gas signal molecule, H2S could regulate autophagy by regulating multiple signal pathways such as Nrf2, NF-κB, MAPK, AMPK, etc., then ameliorated multi-organ dysfunction in sepsis.ConclusionH2S inhibits inflammation, oxidative stress, and apoptosis by regulating autophagy, thus ameliorating multi-organ dysfunction in sepsis, which is expected to become an effective therapeutic target for sepsis.
Objective To study the diagnostic and prognostic value of serum soluble triggering receptor expressed on myeloid cell-1 (sTREM-1) and cyclooxygenase-2 (COX-2) in abdominal infection-caused sepsis. Methods A total of 170 patients with abdominal infection treated in the First Hospital of Qinhuangdao between January 2019 and March 2022 were retrospectively selected and divided into sepsis group (n=76) and non-sepsis group (n=94) according to whether they were combined with abdominal infection-caused sepsis. In addition, 80 healthy people in the same period were selected as the control group. The levels of serum sTREM-1 and COX-2 in the three groups were detected and the differences were compared. The laboratory indexes, including white blood cell count, high-sensitivity C-reactive protein, and procalcitonin of patients with abdominal infection-caused sepsis were detected. The Sequential Organ Failure Assessment score, Acute Physiology and Chronic Health Evaluation System Ⅱ and prognosis (survival or death) of patients with abdominal infection-caused sepsis were evaluated. The correlations of serum sTREM-1 and COX-2 with the severity of sepsis were analyzed, and the diagnostic and prognostic value of sTREM-1 and COX-2 in abdominal infection-caused sepsis was assessed. Results The levels of serum sTREM-1 and COX-2 in the sepsis group were higher than those in the control group and the non-sepsis group (P<0.05). The levels of serum sTREM-1 and COX-2 in the sepsis group were positively correlated with white blood cell count, high-sensitivity C-reactive protein, procalcitonin, Sequential Organ Failure Assessment score, Acute Physiology and Chronic Health Evaluation System Ⅱ score (P<0.05). The serum levels of sTREM-1 and COX-2 of patients who died during hospitalization in the sepsis group were higher than those of the surviving patients. The areas under the receiver operating characteristic curves of the serum sTREM-1 and COX-2 levels for diagnosing sepsis caused by abdominal infection were 0.814 [95% confidence interval (CI) (0.746, 0.882), P<0.001] and 0.848 [95%CI (0.788, 0.905), P<0.001], respectively, with critical values of 1.879 pg/mL and 18.75 ng/mL, respectively, and those for predicting the prognosis of patients with sepsis caused by abdominal infection were 0.775 [95%CI (0.659, 0.890), P<0.001] and 0.784 [95%CI (0.679, 0.889), P<0.001], respectively, with critical values of 2.283 pg/mL and 23.02 ng/mL, respectively (P<0.05). Conclusion The serum levels of sTREM-1 and COX-2 have certain value in the diagnosis and prognosis prediction of abdominal infection-caused sepsis.
Objective To determine the incidence of vitamin B1 deficiency in critically ill patients, to compare vitamin B1 levels between septic and non-septic patients, and to explore the relationship between vitamin B1 levels and lactate levels. Methods Using a retrospective study method, critically ill patients admitted to the Department of Intensive Care of Nanjing Drum Tower Hospital from February 2022 to November 2022 were included in the study, and the patients were divided into sepsis and non-sepsis groups according to the admission diagnosis, and the differences in the vitamin B1 levels of the patients between the two groups were analyzed, as well as the correlation between the vitamin B1 levels and the lactic acid levels. Results There was a significant difference in serum vitamin B1 levels between the sepsis patients and the non-sepsis patients [(1.6±0.3)ng/mL vs. (2.1±0.2)ng/mL, P=0. 009]. For all patients, there was no correlation between vitamin B1 levels and lactate levels. But when the patient was in a hyperlactate state (lactate level ≥2 mmol/L), vitamin B1 levels were significantly negatively correlated with lactate levels (r=–0. 229, P=0. 004). Conclusions Vitamin B1 deficiency is prevalent in critically ill patients and is strongly correlated with whether or not the patient is septic. Vitamin B1 levels are significantly and negatively correlated with lactate levels when the patient's lactate level is ≥2 mmol/L.
ObjectiveTo elucidate the metabolic characteristics of mitochondria in sepsis and review its cellular mechanism, so as to provide new ideas for the treatment of sepsis. MethodThe previous literatures and latest research results about mitochondrial metabolism during sepsis were reviewed. ResultsAt present, the researchers were not only concerned about the inflammatory response of sepsis, but also concerned about the systemic metabolic disorder caused by sepsis. It was believed that the damage of mitochondria caused by sepsis was one of the main reasons for the disorder of cell metabolism. During the sepsis, the patient’s metabolism had changed, for example, enhancement of aerobic glycolysis, lactic acid accumulation, elevated levels of fatty acids and triglycerides in blood, and so on. ConclusionMetabolic change during sepsis is related to mitochondria, which can provide some new methods for treatment of sepsis.
Cytokine storm is a life-threatening hyperinflammatory response. Current limited evidence-based research findings suggest that cytokine adsorption technologies do not reduce mortality in patients undergoing cardiac surgery or those with septic shock, nor do they improve hemodynamics or lower interleukin-6 levels. These negative outcomes may be related to improper timing and method of use, insufficient adsorption efficacy and non-specific adsorption of antibiotics, albumin, platelets, and other substances. This article summarizes the optimal timing for initiating and terminating cytokine adsorption therapy, treatment modality selection, as well as treatment duration and frequency, aiming to provide clinical guidance.
Objective To investigate the protective effect of aprotinin on liver injury in septic rats and its mechanism. Methods Thirty male SPF rats were randomly divided into sham operation group, cecum ligation and puncture (CLP) group and aprotinin intervention group (10 rats in each group). The sham operation group was treated with cecal exploration, CLP group and aprotinin group were treated with CLP method to establish sepsis rat model. The rats in each group were sacrificed 24 hours after operation, and the morphological changes of liver tissue in rats were observed, the serum liver function indicators and inflammatory cytokines levels were detected, and the protein expression of Toll-like receptor (TLR4)/nuclear factor κB (NF-κB) signaling pathway in liver tissue was detected. ResultsIn the CLP group, septic rats exhibited significant inflammatory cell infiltration in hepatic tissue and disordered hepatocyte morphology. Compared with the CLP group, the aprotinin group exhibited nearly normal hepatocyte morphology with significant improvement in vacuolar degeneration. Compared with the sham operation group, the serum aspartate aminotransferase, alanine aminotransferase, tumor necrosis factor-α, interleukin-6 were increased, and the expression of TLR4 and p-NF-κB protein in liver tissue was up-regulated in the CLP group (P<0.05). Compared with the CLP group, serum aspartate aminotransferase, alanine aminotransferase, tumor necrosis factor-α, interleukin-6 were decreased, and the expression of TLR4 and p-NF-κB protein in liver tissue was decreased in the aprotinin group (P<0.05). ConclusionAprotinin may play a protective role against sepsis related liver injury by inhibiting TLR4 / NF-κB signaling axis, reducing the production of inflammatory factors and alleviating inflammatory reactions.
Objective To evaluate the effect of hemoperfusion for absorption of inflammatory cytokines on sepsis . Method A prospective randomized controlled study was carried out to collect 60 sepsis patients admitted to the Department of Critical Care Medicine of this hospital from June 2019 to December 2021. They were randomly divided into a study group (30 cases) and a control group (30 cases) by using the random number table method. Both groups of patients received routine treatment according to the guidelines, including fluid resuscitation, mechanical ventilation, antibiotic and vasoactive agents. For the patients with renal failure, renal replacement therapy (RRT) was used. Routine vital sign monitoring and serum procalcitonin (PCT) and interleukin-6 (IL-6) determination were recorded. The study group received two times of hemoperfusion to absorb inflammatory cytokines at 0 h and 24 h after enrollment. At 24 h and 48 h after treatment, the vital signs and related physical and chemical indexes of patients were recorded again, including norepinephrine dose, oxygenation index, PCT, IL-6 and blood lactic acid. The changes of physical and chemical indexes and the 28-day survival rate of the two groups were compared. Results There was no difference in the general situation of the two groups when they were enrolled (P>0.05). The dosage of norepinephrine [(0.77±0.48)μg·kg–1·min–1 vs. (0.92±0.62) μg·kg–1·min–1, P=0.030] and the level of blood lactic acid [(2.70±1.43)mmol/L vs. (4.05±2.60)mmol/L, P=0.001] in the study group were significantly lower than those in the control group 24 h and 48 h after treatment. The oxygenation index in the study group was higher than that of the control group 24 h after treatment (212±68)mm Hg vs. (197±42)mm Hg, P=0.042). The inflammation related indexes PCT [(17±24)ng/mL vs. (32±36)ng/mL, P=0.013] and IL-6 [299 (102, 853)pg/mL vs. 937 (247, 2230)pg/mL, P=0.026] in the study group were significantly lower than those in the control group 48 h after treatment. The dosage of noradrenaline, oxygenation index, PCT, IL-6 and blood lactate level in the study group after treatment were improved compared with those before treatment (P<0.05), while those in the control group were not significantly improved after treatment (P>0.05), and oxygenation index in the two groups had no significant difference before and after treatment (P>0.05). There was no significant difference in the 28-day survival rate between the two groups (χ2=0.211, P=0.646). Conclusion Although the hemoperfusion for absorption of inflammatory cytokine factors can not reduce the 28-day mortality of sepsis, it can significantly improve the early physical and chemical indicators of patients, and provide opportunities for follow-up treatment.
Objective To systematically evaluate the correlation between serum 25-hydroxyvitamin D [25(OH)D] level and mortality risk in adult with sepsis. Methods We searched PubMed, Cochrane Library, Embase, China National Knowledge Infrastructure, Wanfang, and Chongqing VIP databases for studies on the correlation between serum 25(OH)D and mortality risk in adults with sepsis. The search period was from the establishment of databases to December 2023. Meta-analysis was conducted using RevMan 5.4 software. Results A total of 9 studies were included, with a total of 2267 patients. The meta-analysis results showed that sepsis patients with low serum 25(OH)D levels (<30 ng/mL), insufficient levels (20-30 ng/mL), and deficient levels (<20 ng/mL) had a higher mortality risk compared to those with normal levels (relative risk=1.96, 1.62, 2.21, P<0.05). Subgroup analysis based on different sepsis diagnostic criteria, regions, and research types also showed that sepsis patients with lower serum 25(OH)D levels (<30 ng/mL) had a higher mortality risk compared to those with normal levels (P<0.05). Conclusions Adult sepsis patients with low serum 25(OH)D levels have a higher mortality risk than those with normal levels.
This article aims to interpret the consensus report of the 30th Acute Disease Quality Initiative (ADQI) workgroup on hemoadsorption (HA) technology, providing reference for clinical practice and research. HA has shown therapeutic advantages in various diseases. The ADQI workgroup assessed the research progress of HA technology, confirming its clinically acceptable short-term biocompatibility, safety, and technical feasibility, as well as experimental demonstration of specified target molecule removal. Preliminary studies have shown a potential benefit of endotoxin-based HA in sepsis. However, due to insufficient clinical evidence, HA is still considered an experimental intervention. The ADQI consensus report focuses on filling existing knowledge gaps, pointing out future research directions, and providing important guidance for the clinical application and further research of HA technology.
Sepsis 已經成為危重癥醫學中較為常見的一種綜合征，它定義為因病原體感染而引起的全身性炎癥反應綜合征。嚴重Sepsis患者預后不佳，治療上也較為困難，特別是合并Septic Shock和多器官功能不全綜合征（MODS）的患者，死亡率仍然較高，因此近年來在臨床及研究上均已引起明顯的重視。為了能促進Sepsis的研究及治療，國際上多個醫學專科分會聯合發起“拯救Sepsis運動（Surviving Sepsis Campaign, SSC）”，并于2004年首次發表了相應的指南，即Surviving Sepsis Campaign Guideline for Management of Severe Sepsis and Septic Shock。今年初SSC再次發表了新版的指南，主要是結合近年的研究成果而在原版的基礎上進行適當的補充和更新，以指導臨床上嚴重Sepsis的搶救及治療。
