Please use this identifier to cite or link to this item: http://hdl.handle.net/10995/111571
Title: Sepsis-3: New Edition - Old Problems. Analysis from the Perspective of General Pathology
Other Titles: «Сепсис-3»: новая редакция - старые проблемы. Анализ с позиции общей патологии
Authors: Chereshnev, V. A.
Gusev, E. Yu.
Zotova, N. V.
Issue Date: 2021
Publisher: Saint Petersburg Pasteur Institute
SPb RAACI
Citation: Chereshnev V. A. Sepsis-3: New Edition - Old Problems. Analysis from the Perspective of General Pathology [«Сепсис-3»: новая редакция - старые проблемы. Анализ с позиции общей патологии] / V. A. Chereshnev, E. Yu. Gusev, N. V. Zotova // Russian Journal of Infection and Immunity. — 2021. — Vol. 11. — Iss. 4. — P. 649-662.
Abstract: 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 non-homogeneous 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 pro-inflammatory 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. © 2021 Saint Petersburg Pasteur Institute. All rights reserved.
Keywords: CHRONIC LOW-GRADE INFLAMMATION
COMMON PATHOLOGICAL PROCESS
MICROCIRCULATION
PARAINFLAMMATION
SEPSIS
SEPTIC SHOCK
SYSTEMIC INFLAMMATION
SYSTEMIC INFLAMMATORY REACTION
CLASSICAL INFLAMMATION
CLINICAL FEATURE
CORONAVIRUS DISEASE 2019
GENERAL PATHOLOGY
HUMAN
INFLAMMATION
LOW GRADE INFLAMMATION
PRACTICE GUIDELINE
REVIEW
SEPSIS
SEPTIC SHOCK
SEVERE ACUTE RESPIRATORY SYNDROME CORONAVIRUS 2
SYSTEMIC INFLAMMATORY RESPONSE SYNDROME
VIRUS PATHOGENESIS
URI: http://hdl.handle.net/10995/111571
Access: info:eu-repo/semantics/openAccess
SCOPUS ID: 85116606976
PURE ID: 23747246
ISSN: 2220-7619
metadata.dc.description.sponsorship: This work was carried out within the framework of the state assignment of the Institute of Immunology and Physiology of the Ural Branch of the Russian Academy of Sciences (registration number NIOKTR No. АААА-А18-118020590108-7).
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