Sepsis-3: new edition — old problems. analysis from the perspective of general pathology

Sepsis-3 Guidelines defines sepsis as an organ dysfunction caused by dysregulated host response to infection. To record organ dysfunction, the SOFA/quick SOFA scales were recommended. In fact, in medical practice, sepsis is considered nothing more than a critical infection that requires intensive ca...

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Autores principales:	E. Yu. Gusev, N. V. Zotova, V. A. Chereshnev
Formato:	article
Lenguaje:	RU
Publicado:	Sankt-Peterburg : NIIÈM imeni Pastera 2021
Materias:	sepsis systemic inflammatory reaction systemic inflammation septic shock microcirculation parainflammation common pathological process chronic low-grade inflammation Infectious and parasitic diseases RC109-216
Acceso en línea:	https://doaj.org/article/d74b1ad829fb49a1a5293cf02a7954be
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spelling	oai:doaj.org-article:d74b1ad829fb49a1a5293cf02a7954be2021-11-22T07:09:55ZSepsis-3: new edition — old problems. analysis from the perspective of general pathology2220-76192313-739810.15789/2220-7619-SAN-1629https://doaj.org/article/d74b1ad829fb49a1a5293cf02a7954be2021-09-01T00:00:00Zhttps://www.iimmun.ru/iimm/article/view/1629https://doaj.org/toc/2220-7619https://doaj.org/toc/2313-7398Sepsis-3 Guidelines defines sepsis as an organ dysfunction caused by dysregulated host response to infection. To record organ dysfunction, the SOFA/quick SOFA scales were recommended. In fact, in medical practice, sepsis is considered nothing more than a critical infection that requires intensive care. Therefore, sepsis is pathogenetically a nonhomogeneous condition manifested by diverse nosologies and syndromes. Unlike the previous two editions, Sepsis-1 and Sepsis-2 Guidelines, the formal criteria provided in the Sepsis-3 are closer to the de facto position, describe more specific, but less sensitive features to predict mortality. However, the initial, latent manifestations of critical conditions, which can be relatively effectively controlled by intensive therapy, remain outside the Sepsis-3 criteria. Not all signs of multiple organ dysfunctions (according to the Sepsis-3 criteria) will require intensive care. Hence, obviously the presence or absence of formal criteria of Sepsis-3 will not be always taken into account while verifying sepsis. The only relatively pathogenetically homogeneous definition in Sepsis-3 is “septic shock”. However, it also does not fully consider the staging (according to the degree of compensation of hemodynamic disturbances) and the phasing (according to the severity of the proinflammatory response) of the dynamics of the shock condition. From our point of view, a positive result of the Sepsis-3 consensus would be in transition of the systemic inflammatory response syndrome (SIRS) from the main to additional (optional) verifying sepsis criteria. We also believe that the weak side of the Sepsis-3 Guidelines is in underestimated mechanisms of systemic inflammation as a general pathological process in the genesis of developing critical conditions of various origins. From the perspective of general pathology, sepsis is a combination of the three common fundamental pathological processes: classical (canonical) and systemic inflammation (SI), as well as chronic systemic low-grade inflammation (parainflammation), the latter can be considered as an unfavorable background for development of the former two processes. All three processes are characterized by any SIR signs and require to be differentiated on the basis of integral criteria, which reflect specific blocks of the SI complex process. The pathogenesis of the SARS-CoV-2 infection (COVID-19) is a relevant example underlying inevitability of such approach. The systemic microvascular vasculitis, and its main clinical manifestations such as systemic microcirculatory disorders in the form of shockogenic conditions is the SI pathogenetic basis. Apparently, one of the modalities for further evolution of critical care medicine will be coupled to development of a more multilayered but effective methods for assessing pathogenesis of critical states and more differentiated methods of pathogenetic therapy. Therefore, it will require to modernize a number of fundamental premises in our knowledge about pathobiology, pathophysiology, and general pathology.E. Yu. GusevN. V. ZotovaV. A. ChereshnevSankt-Peterburg : NIIÈM imeni Pasteraarticlesepsissystemic inflammatory reactionsystemic inflammationseptic shockmicrocirculationparainflammationcommon pathological processchronic low-grade inflammationInfectious and parasitic diseasesRC109-216RUInfekciâ i Immunitet, Vol 11, Iss 4, Pp 649-662 (2021)
institution	DOAJ
collection	DOAJ
language	RU
topic	sepsis systemic inflammatory reaction systemic inflammation septic shock microcirculation parainflammation common pathological process chronic low-grade inflammation Infectious and parasitic diseases RC109-216
spellingShingle	sepsis systemic inflammatory reaction systemic inflammation septic shock microcirculation parainflammation common pathological process chronic low-grade inflammation Infectious and parasitic diseases RC109-216 E. Yu. Gusev N. V. Zotova V. A. Chereshnev Sepsis-3: new edition — old problems. analysis from the perspective of general pathology
description	Sepsis-3 Guidelines defines sepsis as an organ dysfunction caused by dysregulated host response to infection. To record organ dysfunction, the SOFA/quick SOFA scales were recommended. In fact, in medical practice, sepsis is considered nothing more than a critical infection that requires intensive care. Therefore, sepsis is pathogenetically a nonhomogeneous condition manifested by diverse nosologies and syndromes. Unlike the previous two editions, Sepsis-1 and Sepsis-2 Guidelines, the formal criteria provided in the Sepsis-3 are closer to the de facto position, describe more specific, but less sensitive features to predict mortality. However, the initial, latent manifestations of critical conditions, which can be relatively effectively controlled by intensive therapy, remain outside the Sepsis-3 criteria. Not all signs of multiple organ dysfunctions (according to the Sepsis-3 criteria) will require intensive care. Hence, obviously the presence or absence of formal criteria of Sepsis-3 will not be always taken into account while verifying sepsis. The only relatively pathogenetically homogeneous definition in Sepsis-3 is “septic shock”. However, it also does not fully consider the staging (according to the degree of compensation of hemodynamic disturbances) and the phasing (according to the severity of the proinflammatory response) of the dynamics of the shock condition. From our point of view, a positive result of the Sepsis-3 consensus would be in transition of the systemic inflammatory response syndrome (SIRS) from the main to additional (optional) verifying sepsis criteria. We also believe that the weak side of the Sepsis-3 Guidelines is in underestimated mechanisms of systemic inflammation as a general pathological process in the genesis of developing critical conditions of various origins. From the perspective of general pathology, sepsis is a combination of the three common fundamental pathological processes: classical (canonical) and systemic inflammation (SI), as well as chronic systemic low-grade inflammation (parainflammation), the latter can be considered as an unfavorable background for development of the former two processes. All three processes are characterized by any SIR signs and require to be differentiated on the basis of integral criteria, which reflect specific blocks of the SI complex process. The pathogenesis of the SARS-CoV-2 infection (COVID-19) is a relevant example underlying inevitability of such approach. The systemic microvascular vasculitis, and its main clinical manifestations such as systemic microcirculatory disorders in the form of shockogenic conditions is the SI pathogenetic basis. Apparently, one of the modalities for further evolution of critical care medicine will be coupled to development of a more multilayered but effective methods for assessing pathogenesis of critical states and more differentiated methods of pathogenetic therapy. Therefore, it will require to modernize a number of fundamental premises in our knowledge about pathobiology, pathophysiology, and general pathology.
format	article
author	E. Yu. Gusev N. V. Zotova V. A. Chereshnev
author_facet	E. Yu. Gusev N. V. Zotova V. A. Chereshnev
author_sort	E. Yu. Gusev
title	Sepsis-3: new edition — old problems. analysis from the perspective of general pathology
title_short	Sepsis-3: new edition — old problems. analysis from the perspective of general pathology
title_full	Sepsis-3: new edition — old problems. analysis from the perspective of general pathology
title_fullStr	Sepsis-3: new edition — old problems. analysis from the perspective of general pathology
title_full_unstemmed	Sepsis-3: new edition — old problems. analysis from the perspective of general pathology
title_sort	sepsis-3: new edition — old problems. analysis from the perspective of general pathology
publisher	Sankt-Peterburg : NIIÈM imeni Pastera
publishDate	2021
url	https://doaj.org/article/d74b1ad829fb49a1a5293cf02a7954be
work_keys_str_mv	AT eyugusev sepsis3neweditionoldproblemsanalysisfromtheperspectiveofgeneralpathology AT nvzotova sepsis3neweditionoldproblemsanalysisfromtheperspectiveofgeneralpathology AT vachereshnev sepsis3neweditionoldproblemsanalysisfromtheperspectiveofgeneralpathology
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Sepsis-3: new edition — old problems. analysis from the perspective of general pathology

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