ObjectiveTo summarize the mechanism of hydrogen sulfide (H2S) in regulating autophagy and ameliorating multi-organ dysfunction in the treatment of sepsis.MethodThe relevant literatures at home and abroad in recent years were systematically searched and read to review the mechanism of H2S in regulating autophagy and ameliorating multi-organ dysfunction during sepsis.ResultsAs a new medical gas signal molecule, H2S could regulate autophagy by regulating multiple signal pathways such as Nrf2, NF-κB, MAPK, AMPK, etc., then ameliorated multi-organ dysfunction in sepsis.ConclusionH2S inhibits inflammation, oxidative stress, and apoptosis by regulating autophagy, thus ameliorating multi-organ dysfunction in sepsis, which is expected to become an effective therapeutic target for sepsis.
Objective To investigate the diagnosis and treatment strategy of urosepsis caused by ureteral calculi in solitary kidney. Methods The clinical data of patients with urosepsis caused by ureteral calculi in solitary kidney in the Department of Urology of Chengdu 363 Hospital Affiliated to Southwest Medical University from March 2015 to March 2020 were analyzed retrospectively. Results A total of 23 patients were included. One patient received ureteroscopic holmium laser lithotripsy, after which urosepsis and renal function deteriorated, then got better after anti-infection and hemodialysis treatment in intensive care unit; 17 patients received implantation of ureteral stent by cystoscopy, and 5 patients received percutaneous nephrostomy by ultrasound guiding, the 22 patients received ureteroscopic lithotripsy or flexible ureteroscopic lithotripsy electively. One patients had subcapsular renal hematoma postoperatively and worse renal insufficiency, the rest 22 patients had improved renal function. All patients were cured clinically. Conclusions For solitary kidney patients who have urosepsis caused by ureteral calculi, emergency treatment is necessary. The relief of urinary obstruction must be based on effective anti-infection. Choosing cystoscopic ureteral stent implantation or percutaneous nephrostomy depends on patients’ individualization. Ureterscopic lithotripsy simultaneously is not recommended. Ureteral intubation before cystoscopic ureteral stent implantation is important, which can increase the success rate of ureteral stent implantation.
Sepsis is a multiple organ dysfunction syndrome caused by a dysregulated host response to infection. The mortality rate remains high under current treatment methods, and there is an urgent need to explore new therapeutic targets. Ubiquitination modification, as a key posttranslational regulation mechanism of proteins, plays a central role in the occurrence and development of sepsis and multiple organ damage by regulating key pathological processes such as inflammatory response, cell death and barrier function. This article aims to systematically elucidate the molecular mechanism of ubiquitination modification system in sepsis related organ damage, summarize the latest research progress on treatment strategies targeting the ubiquitination pathway, and explore the challenges and future transformation directions faced in this field. Through comprehensive analysis of existing research, this review aims to provide new ideas and theoretical basis for precise treatment of sepsis.
ObjectiveTo elucidate the metabolic characteristics of mitochondria in sepsis and review its cellular mechanism, so as to provide new ideas for the treatment of sepsis. MethodThe previous literatures and latest research results about mitochondrial metabolism during sepsis were reviewed. ResultsAt present, the researchers were not only concerned about the inflammatory response of sepsis, but also concerned about the systemic metabolic disorder caused by sepsis. It was believed that the damage of mitochondria caused by sepsis was one of the main reasons for the disorder of cell metabolism. During the sepsis, the patient’s metabolism had changed, for example, enhancement of aerobic glycolysis, lactic acid accumulation, elevated levels of fatty acids and triglycerides in blood, and so on. ConclusionMetabolic change during sepsis is related to mitochondria, which can provide some new methods for treatment of sepsis.
This article aims to interpret the consensus report of the 30th Acute Disease Quality Initiative (ADQI) workgroup on hemoadsorption (HA) technology, providing reference for clinical practice and research. HA has shown therapeutic advantages in various diseases. The ADQI workgroup assessed the research progress of HA technology, confirming its clinically acceptable short-term biocompatibility, safety, and technical feasibility, as well as experimental demonstration of specified target molecule removal. Preliminary studies have shown a potential benefit of endotoxin-based HA in sepsis. However, due to insufficient clinical evidence, HA is still considered an experimental intervention. The ADQI consensus report focuses on filling existing knowledge gaps, pointing out future research directions, and providing important guidance for the clinical application and further research of HA technology.
Objective To compare clinical outcomes of percutaneous nephrolithotomy (PCNL) in patients who initially presented with and without urosepsis. Methods The study included patients who underwent PCNL for renal and ureter urolithiasis removal from January 2010 to December 2014 in our hospital. A 1∶1 matched-pair analysis was performed to compare outcomes and complications of patients who had obstructive urolithiasis with urosepsis initially (OUU) with patients who had obstructive urolithiasis with no urosepsis initially (NOUU) before PCNL. Results A total of 172 patients were included involving 122 (71%) males and 50 (29%) females with a mean age of 46.2 years (range 32 to 65 years). There were no significant differences between two groups in age, gender, BMI, complications, the size of the stones, stone's number and stone location (P>0.05). OUU groups had the similar stone-free rates (86.0%vs. 84.8%, P=0.829) as the NOUU group. OUU group had higher overall complications rate, longer duration of nephrostomy tube (NT), longer hospital length of stay (LOS), longer courses of postoperative antibiotics and higher grade of antibiotics after PCNL (all P<0.05). Higher fever developed postoperatively (11.6%vs. 3.5%, P=0.043), higher asymptomatic bacteriuria (11.6% vs. 3.5%, P=0.043) and symptomatic urinary tract infections (10.5% vs. 2.3%, P=0.029) were also found in OUU groups. There was no significant difference between two groups in sepsis (2.3% vs. 1.2%, P=0.560). Conclusion PCNL after decompression for urolithiasis-related urosepsis has similar success but higher complication rates than obstructive urolithiasis with no urosepsis initially.
Objective To systematically evaluate the effect of vitamin C supplementation on the mortality of patients with sepsis and septic shock. Methods The Cochrane Library, PubMed, EMbase, Wanfang Data Knowledge Service Platform, China National Knowledge Infrastructure Database and Chinese Science and Technology Periodical Database were searched by computer for randomized controlled trials (RCTs) on the effect of vitamin C on the mortality of patients with sepsis. The retrieval time of each database was from the establishment of the database to January 20, 2022. Two researchers independently screened the literature, extracted data, and evaluated the quality, and then used STATA 16.0 software for meta-analysis. Results A total of 15 RCTs were included, with a total of 2077 patients, including 1041 in the experimental group and 1036 in the control group. The results of literature quality showed that 7 studieswere grade A and 8 studies were grade B, indicating that the overall quality of the included literature was good. The results of meta-analysis showed that compared with the control group, the mortality of patients with sepsis and septic shock in the experimental group were effectively reduced [odds ratio (OR)=0.81, 95% confidential interval (CI) 0.67 - 0.98, P=0.027]. The results of subgroup analysis showed that vitamin C supplementation therapy for more than 4 days could significantly reduce the mortality of the patients with sepsis (OR=0.67, 95%CI 0.49 - 0.90, P=0.008); single treatment could significantly reduce the mortality rate of patients with sepsis (OR=0.50, 95%CI 0.34 - 0.74, P=0.001); vitamin C supplementation can effectively reduce the short-term (≤30 days) mortality of patients with sepsis (OR=0.77, 95%CI 0.63 - 0.96, P=0.017). The funnel plot showed that the included literature was basically symmetrical, and publication bias could not be considered. Conclusions Vitamin C supplementation can effectively reduce the mortality rate of patients with sepsis and septic shock. Vitamin C supplementation treatment course of 4 days or less and single treatment can reduce the mortality rate of patients with sepsis and septic shock, but cannot reduce the long-term (90 days) mortality rate of patients.
Sepsis-associated acute kidney injury (SAKI) is a common complication of patients in intensive care unit, and also an independent risk factor leading to high mortality of sepsis patients. SAKI leads to an extended hospital stay for patients, resulting in a huge medical burden. The pathogenesis of SAKI is complex, and systemic inflammatory response plays an important role in it. At present, blood adsorption is the main method for treating SAKI in intensive care units, but there is no consensus on the relevant treatment strategies. This article summarizes new perspectives and research conclusions on the application of blood adsorption technology in the treatment of SAKI, aiming to provide new references for the blood adsorption treatment strategies of SAKI.
Objective To explore the value of quick Sequential Organ Failure Assessment (qSOFA) score and blood markers in differentiating and predicting emergency heat stroke from sepsis, and to construct a rapid differentiation model. Methods A retrospective cohort study was conducted, including heat stroke patients and sepsis patients admitted to the Chongqing Emergency Medical Center between January 2021 and December 2024. The qSOFA score and blood marker indicators at admission were collected, with the “final diagnosis (sepsis or heat stroke) within 48 hours after admission” as the study endpoint. The logistic regression analysis method was selected to screen for independent predictive factors, construct a joint prediction model, and evaluate the discriminant efficacy using the area under the curve (AUC) of the receiver operating characteristic. Results A total of 133 sepsis patients and 66 heat stroke patients were included. The qSOFA score showed differentiation ability in univariate analysis (P=0.002), but had no independent predictive value after adjusting for diabetes, age, and gender (P=0.565). The results of multiple logistic regression analysis showed that procalcitonin (PCT), C-reactive protein (CRP), and monocyte count (MONO) were independent predictive factors (P<0.05). The combined prediction model of PCT, CRP, and MONO (AUC=0.984) showed higher discriminatory efficacy than PCT (AUC=0.809), CRP (AUC=0.886), and MONO (AUC=0.671). Conclusions The prediction model constructed by combining PCT, CRP, and MONO has good efficiency in differentiating sepsis from heat stroke, providing a reliable clinical decision-making tool for early accurate differentiation in the emergency department.
Objective To establish a short-term mortality risk scoring standard for sepsis-associated acute respiratory distress syndrome (sARDS) and provide a reference tool for clinicians to evaluate the severity of sARDS patients. Methods A retrospective cohort study was conducted on sARDS patients admitted to the adult intensive care unit (ICU) of the First Affiliated Hospital, Hengyang Medical School, University of South China from January 1, 2013 to August 31, 2020. They were divided into a death group and a survival group according to whether they died within 28 days after admission to ICU. Clinical data of the patients was collected within 24 hours admitted to ICU. Related risk factors for mortality within 28 days after admission to ICU were screened out through univariate logistic regression analysis. A risk prediction model for mortality within 28 days after admission to ICU was established by multivariate logistic regression analysis. The Hosmer-Lemeshow χ2 test and the area under the receiver operating characteristic (ROC) curve were used to evaluate the model’s goodness-fit and accuracy in predicting 28-day mortality of the sARDS patients, respectively. Finally, the clinical prognosis scoring criteria 28-day mortality of the sARDS patients were established according to the weight coefficients of each independent risk factor in the model. Results A total of 150 patients were recruited in this study. There were 67 patients in the survival group and 83 patients in the death group with a 28-day mortality rate of 55.3%. Four independent risk factors for 28-day mortality of the sARDS patients, including invasive mechanical ventilation, the number of dysfunctional organs≥3, serum lactic acid≥4.3 mmol/L and the severity of ARDS. A risk prediction model for mortality within 28 days of the sARDS patients was established. The area under the ROC curve and 95% confidence interval (CI), sensitivity and specificity of the risk prediction model for 28-day mortality for the sARDS patients were 0.896 (95%CI 0.846 - 0.945), 80.7% and 82.1%, respectively, while that for acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) score were 0.865 (95%CI 0.805 - 0.925), 71.1% and 89.6%; for sequential organ failure assessment (SOFA) score were 0.841 (95%CI 0.7799 - 0.904), 68.7%, and 82.1%; for the prediction scores of lung injury were 0.855 (95%CI 0.789 - 0.921), 81.9% and 82.1%, respectively. It was indicated that the prediction accuracy of this risk prediction model of 28-day mortality maybe was better than that of APACHE-Ⅱ score, SOFA score and prediction score of lung injury. In addition, four risk factors were assigned as invasive mechanical ventilation (12 points), serum lactic acid≥4.3mmol /L (1 point), number of organs involved≥3 (3 points), and severity of ARDS (mild for 13 points, moderate for 26 points, severe for 39 points). Further more, the score of each patient was 13 - 55 points according to the scoring criteria, and the score grade was made according to the percentile method: 13 - 23 points for the low-risk group for 28-day mortality, 24 - 34 points for the medium-risk group for 28-day mortality, 35 - 45 points for the high-risk group for 28-day mortality, and over 45 points for the extremely high-risk group for 28-day mortality. According to the scoring criteria, the prognosis of the patients in this study was analyzed. The mortality probability of each group was 0.0% in the low-risk group, 13.8% in the medium-risk group, 51.9% in the high-risk group, and 89.7% in the extremely high-risk group, respectively. Conclusions The invasive mechanical ventilation, the number of involved organs≥3, serum lactic acid≥4.3 mmol /L and the severity of sARDS are independent risk factors for 28-day mortality of the sARDS patients. The scoring criteria may predict the risk of 28-day mortality for the sARDS patients.