Sepsis Definitions

Abstract

This book is designed to provide a comprehensive and state-of-the-art resource for clinicians who care for patients with sepsis and research scientist alike, . Patients with severe sepsis requiring ICU admission have very high rates of ICU and overall hospital mortality, with estimates ranging from 18 to 50%. Risk factors for death from sepsis include underlying illness, increased age, and multi-system organ failure. This is compounded by the significant variation in the management of early severe sepsis. Care of these patients and clinical conditions can be quite complex, and materials are collected from the most current, evidence-based resources. Book sections have been structured to review the overall definitions and epidemiology of sepsis as well as current insights into the pathophysiology of sepsis. This review summarizes the evidence for the international consensus guidelines for the identification and management of sepsis. The latter part of this book reviews emerging concepts and approaches in the diagnosis and management of sepsis that may significantly reduce mortality in the future. Sepsis: Pathophysiology, Definitions and the Challenge of Bedside Management represents a collaboration between authors drawn from a variety of disciplines and contributions from basic scientists and highly recognized clinical opinion leaders with expertise in clinical trials. Preface; Contents; Contributors; Part I; Chapter 1: Introduction; References; Chapter 2: Sepsis Definitions; Introduction; History of the Definition of Sepsis; Origins of the Definition of Sepsis; 1991 International Consensus Conference; 2001 International Consensus Conference; 2010 Merinoff Symposium; 2016 The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3); Difficulties in Defining Sepsis; Shortcomings of the SIRS Criteria; Staging of Sepsis; Problems with in Early Stage Sepsis; Adoption of the Term "Septic" in Medical Culture. Defining Sepsis Through Clinical or Administrative Data Coding; Criteria; Angus Criteria; Martin Criteria; Comparison of Different Methods; Trends in Mortality and Disability in Sepsis; Future Directions; Conclusions; References; Chapter 3: Epidemiology of Sepsis: Current Data and Predictions for the Future; Introduction; Incidence and Outcome of Sepsis; Global Cohorts; The Cost of Sepsis; Long-Term Outcomes; Demographic and Genetic Factors; Gender; Race; Socioeconomic Status; Biological Factors; Comorbidities; Malignancy; HIV; Obesity; Diabetes. Anti-Inflammatory Cytokines IL-10; Chemotactic Cytokines; Complement and Coagulation Cascades; Antimicrobial Peptides; Lipid Mediators; Prostanoids and Leukotriene; Reactive Oxygen Species (ROSs), Reactive Nitrogen Species (RNSs), and Nitric Oxide (NO); Immune Resolution of Sepsis; Summary; References; Chapter 5: Sepsis-Induced Immune Suppression; Introduction; Cytokines in Sepsis-Induced Immune Suppression; The Role of Immune Cells in Sepsis-Induced Immunosuppression; Impaired Immune Cell Function and Programmed Cell Death in Sepsis; Neutrophils; Antigen Presenting Cells. Dendritic Cells Monocytes/Macrophages; Lymphocytes; Natural Killer Cells; CD4+ TH Cells; γδ T Cells; Regulatory T Cells; Predicting Clinical Outcomes with Biomarkers of Sepsis-ƯInduced Immunosuppression; Potential Therapeutic Interventions in Sepsis-Induced Immune Suppression; Interleukin-10; Interleukin 7 (IL-7); Interleukin 15 (IL-15); Programmed Cell Death Receptor-1 (PD-1) and Programmed Cell Death Ligand-1 (PD-L1); Granulocyte Macrophage Colony-Stimulating Factor (GM-CSF); Interferon-Gamma; Conclusion; References; Chapter 6: Molecular Targets for Therapy; Introduction. Etiology and Source of Infection Conclusions; References; Part II; Chapter 4: Overview of the Molecular Pathways and Mediators of Sepsis; Background; Introduction to Innate and Adaptive Immune Responses; Innate Immunity; Adaptive Immunity; Cells Involved in Immune Response in Sepsis; Monocytes and Macrophages; Dendritic Cells; Neutrophils; Natural Killer Cells; Other Innate Regulatory Cells; CD4+/CD8+ T and B Lymphocyte Cells; Alterations in Sepsis; Inflammatory Cytokines and Chemokines; TNF-α and IL-1; MIF and HMGB-1; Future Diagnostic Inflammatory Markers.