title: Sepsis and septic shock.
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.
authors.affiliation: Department of Anesthesiology, Washington University of St. Louis, St. Louis, Missouri, USA.
authors.forename: Richard S
authors.initials: RS
authors.lastname: Hotchkiss
authors.affiliation: Department of Surgery, University of Florida College of Medicine, Shands Hospital, Room 6116, 1600 SW Archer Road, Gainesville, Florida 32610-0019, USA.
authors.forename: Lyle L
authors.initials: LL
authors.lastname: Moldawer
authors.affiliation: Department of Infectious Diseases and Medicine, Alpert Medical School of Brown University, Providence, Rhode Island, USA.
authors.forename: Steven M
authors.initials: SM
authors.lastname: Opal
authors.affiliation: Department of Anesthesiology and Intensive Care, Jena University Hospital, Jena, Germany.
authors.forename: Konrad
authors.initials: K
authors.lastname: Reinhart
authors.affiliation: Department of Anesthesiology, Washington University of St. Louis, St. Louis, Missouri, USA.
authors.forename: Isaiah R
authors.initials: IR
authors.lastname: Turnbull
authors.affiliation: Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium.
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Vincent
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use; D015415:Biomarkers / Q000032:analysis* / Q000097:blood; D001778:Blood Coagulation Disorders / Q000209:etiology / Q000401:mortality; D018932:Chemokine CCL2 / Q000032:analysis / Q000097:blood; D054357:Chemokine CXCL10 / Q000032:analysis / Q000097:blood; D005334:Fever / Q000209:etiology; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D007035:Hypothermia / Q000209:etiology; D017053:Infection Control / Q000379:methods; D016753:Interleukin-10 / Q000032:analysis / Q000097:blood; D015850:Interleukin-6 / Q000032:analysis / Q000097:blood; D009102:Multiple Organ Failure / Q000209:etiology; D063305:Organ Dysfunction Scores; D044087:Receptor, Anaphylatoxin C5a / Q000032:analysis / Q000037:antagonists & inhibitors / Q000097:blood; D018805:Sepsis / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology*; D012772:Shock, Septic / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology*; D018746:Systemic Inflammatory Response Syndrome / Q000150:complications; D013610:Tachycardia / Q000209:etiology; D059246:Tachypnea / Q000209:etiology
chemical_list: D000900:Anti-Bacterial Agents; D015415:Biomarkers; C111835:CCL2 protein, human; C114753:CXCL10 protein, human; D018932:Chemokine CCL2; D054357:Chemokine CXCL10; C508609:IL10 protein, human; C508600:IL6 protein, human; D015850:Interleukin-6; D044087:Receptor, Anaphylatoxin C5a; D016753:Interleukin-10