Persistent Inflammation, Immunosuppression, and Catabolism Syndrome in Sepsis
Journal: Journal of Clinical Medicine Research DOI: 10.32629/jcmr.v5i1.1785
Abstract
Sepsis is a life-threatening organ dysfunction resulting from a dysregulated host response to infection. Early recognition and appropriate management improve in-hospital mortality in patients with sepsis. However, many patients progress to chronic critical illness (CCI). Persistent inflammation, immunosuppression, and catabolic syndrome (PICS), a new phenotype of CCI, is characterized by chronic low-grade inflammation, host immunosuppression, and catabolic-dominant weight loss. Due to the complexity of the pathophysiologic mechanisms of PICS, there is no effective treatment available. The aim of this review is to increase understanding of the pathophysiological mechanisms of PICS in sepsis, to summarize the diagnostic criteria and potential treatments for PICS, and to help clinicians adopt more comprehensive measures to improve the long-term prognosis of patients with PICS.
Keywords
sepsis, persistent inflammation, immunosuppression, and catabolism syndrome, pathophysiology, treatment
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[5] Gentile LF, Cuenca AG, Efron PA, Ang D, Bihorac A, McKinley BA, et al. Persistent inflammation and immunosuppression: a common syndrome and new horizon for surgical intensive care. J Trauma Acute Care Surg. 2012;72(6):1491-501. https://doi.org/10.1097/TA.0b013e318256e000.
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[7] Stortz JA, Raymond SL, Mira JC, Moldawer LL, Mohr AM, Efron PA. Murine Models of Sepsis and Trauma: Can We Bridge the Gap? ILAR J. 2017;58(1)https://doi.org/10.1093/ilar/ilx007.
[8] Kang J-W, Kim S-J, Cho H-I, Lee S-M. DAMPs activating innate immune responses in sepsis. Ageing Res Rev. 2015;24(Pt A):54-65. https://doi.org/10.1016/j.arr.2015.03.003.
[9] Darden DB, Kelly LS, Fenner BP, Moldawer LL, Mohr AM, Efron PA. Dysregulated Immunity and Immunotherapy after Sepsis. J Clin Med. 2021;10(8)https://doi.org/10.3390/jcm10081742.
[10] Mira JC, Gentile LF, Mathias BJ, Efron PA, Brakenridge SC, Mohr AM, et al. Sepsis Pathophysiology, Chronic Critical Illness, and Persistent Inflammation-Immunosuppression and Catabolism Syndrome. Crit Care Med. 2017;45(2):253-62. https://doi.org/10.1097/CCM.0000000000002074.
[11] Manz MG, Boettcher S. Emergency granulopoiesis. Nat Rev Immunol. 2014;14(5):302-14. https://doi.org/10.1038/nri3660.
[12] Dai J, El Gazzar M, Li GY, Moorman JP, Yao ZQ. Myeloid-derived suppressor cells: paradoxical roles in infection and immunity. J Innate Immun. 2015;7(2):116-26. https://doi.org/10.1159/000368233.
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[18] Stortz JA, Mira JC, Raymond SL, Loftus TJ, Ozrazgat-Baslanti T, Wang Z, et al. Benchmarking clinical outcomes and the immunocatabolic phenotype of chronic critical illness after sepsis in surgical intensive care unit patients. J Trauma Acute Care Surg. 2018;84(2):342-9. https://doi.org/10.1097/TA.0000000000001758.
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[26] Cetinbas F, Yelken B, Gulbas Z. Role of glutamine administration on cellular immunity after total parenteral nutrition enriched with glutamine in patients with systemic inflammatory response syndrome. J Crit Care. 2010;25(4):661.e1-.e6. https://doi.org/10.1016/j.jcrc.2010.03.011.
[27] Kim H. Glutamine as an immunonutrient. Yonsei Med J. 2011;52(6):892-7. https://doi.org/10.3349/ymj.2011.52.6.892.
[28] Kim T, Kim H. Pathophysiology and Therapeutic Management of Bone Loss in Patients with Critical Illness. Pharmaceuticals (Basel). 2023;16(12)https://doi.org/10.3390/ph16121718.
[29] Kayambu G, Boots R, Paratz J. Early physical rehabilitation in intensive care patients with sepsis syndromes: a pilot randomised controlled trial. Intensive Care Med. 2015;41(5):865-74. https://doi.org/10.1007/s00134-015-3763-8.
[30] Dirks ML, Hansen D, Van Assche A, Dendale P, Van Loon LJC. Neuromuscular electrical stimulation prevents muscle wasting in critically ill comatose patients. Clin Sci (Lond). 2015;128(6):357-65. https://doi.org/10.1042/CS20140447.
[31] Page VJ, McAuley DF. Sedation/drugs used in intensive care sedation. Curr Opin Anaesthesiol. 2015;28(2):139-44. https://doi.org/10.1097/ACO.0000000000000174.
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