Pathophysiology of Sepsis

• Published in: The American journal of pathology Vol. 170; no. 5; pp. 1435 - 1444
• Main Author: Remick, Daniel G., M.D
• Format: Journal Article
• Language: English
• Published: Bethesda, MD Elsevier Inc 01-05-2007; ASIP; American Society for Investigative Pathology
• Subjects: Anti-Inflammatory Agents - therapeutic use; Bacterial diseases; Bacterial sepsis; Biological; Biological and medical sciences; Clinical Trials as Topic; Human bacterial diseases; Humans; Infectious diseases; Investigative techniques, diagnostic techniques (general aspects); Medical sciences; Pathology; Pathology. Cytology. Biochemistry. Spectrometry. Miscellaneous investigative techniques; Sepsis - drug therapy; Sepsis - physiopathology; Signal Transduction - physiology; Infection; Sepsis syndrome; Bacteriosis; Anatomic pathology; Pathophysiology; Bacteremia
• ISSN: 0002-9440; 1525-2191
• DOI: 10.2353/ajpath.2007.060872

Sepsis remains a critical problem with significant morbidity and mortality even in the modern era of critical care management. Multiple derangements exist in sepsis involving several different organs and systems, although controversies exist over their individual contribution to the disease process. Septic patients have substantial, life-threatening alterations in their coagulation system, and currently, there is an approved therapy with a component of the coagulation system (activated protein C) to treat patients with severe sepsis. Previously, it was believed that sepsis merely represented an exaggerated, hyperinflammatory response with patients dying from inflammation-induced organ injury. More recent data indicate that substantial heterogeneity exists in septic patients' inflammatory response, with some appearing immuno-stimulated, whereas others appear suppressed. Cellular changes continue the theme of heterogeneity. Some cells work too well such as neutrophils that remain activated for an extended time. Other cellular changes become accelerated in a detrimental fashion including lymphocyte apoptosis. Metabolic changes are clearly present, requiring close and individualized monitoring. At this point in time, the literature richly illustrates that no single mediator/system/pathway/pathogen drives the pathophysiology of sepsis. This review will briefly discuss many of the important alterations that account for the pathophysiology of sepsis.