[Immunomodulating strategies in the treatment of sepsis].
Sepsis is associated with the activation of several inflammatory cascades, including the cytokine network and the coagulation system, but it can also be associated with an immunodepressed state. This can lead to a situation in which the septic patient becomes more susceptible to secondary infections. In animal experiments, inhibition of the cytokine cascade by administration of tumour necrosis factor alpha (TNF alpha)-receptors or anti-TNF alpha antibodies has led to reduced mortality, but this has not been confirmed in clinical trials. After the data were pooled, there was a statistically significant decrease in mortality of 3-5%. Treatment with endotoxin antibodies, corticosteroids in high doses, other anti-inflammatory agents and agents designed to eliminate immunodepression generally also did not produce a convincing decrease in mortality. Research on antithrombotic agents has yielded, along with disappointing results with antithrombin III and 'tissue factor pathway inhibitor', one study with a positive result. In septic patients with organ failure who were treated with activated protein C, a coagulation inhibitor, the mortality decreased from 30.8 to 24.7%.
Schultz
M J
MJ
Afd. Intensive Care Volwassenen, Academisch Medisch Centrum/Universiteit van Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam. m.j.schultz@amc.uva.nl
van der Poll
T
T
D000276:Adjuvants, Immunologic / Q000627:therapeutic use*; D000818:Animals; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D000925:Anticoagulants / Q000627:therapeutic use; D016207:Cytokines / Q000037:antagonists & inhibitors; D004195:Disease Models, Animal; D006801:Humans; D018805:Sepsis / Q000150:complications / Q000188:drug therapy* / Q000276:immunology
D000276:Adjuvants, Immunologic; D000893:Anti-Inflammatory Agents; D000925:Anticoagulants; D016207:Cytokines