Articles: sepsis.
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Megakaryocytes are traditionally recognized as cells responsible for platelet production. However, beyond their role in thrombopoiesis, megakaryocytes also participate in inflammatory responses and regulate immune system functions. Sepsis, characterized by life-threatening organ dysfunction due to a dysregulated response to infection, prominently features coagulopathy, severe inflammation, and immune dysfunction as key pathophysiological aspects. ⋯ The purpose of this review is to both highlight and provide an update on the functions of megakaryocytes and pathophysiological changes in sepsis. Specific emphasis is given to the role of megakaryocytes in sepsis, which suggests value of future research and clinical application.
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Sepsis is the result of a dysregulated immune response to infection and is associated with acute organ dysfunction. The syndrome's complexity is contingent upon the underlying pathology and individual patient characteristics, including their immune response. The involvement of multiple organs and physiological functions adds complexity, with "organ cross-talk" emerging as a pivotal pathophysiological and clinical aspect. This narrative review to evaluate the rationale and available clinical evidence supporting the use of extracorporeal blood purification therapies as adjunctive therapy in patients with sepsis and septic shock. ⋯ Given the heterogeneity of patients with sepsis, conducting traditional randomized clinical trials in this domain can be a daunting task. However, statistical techniques such as Bayesian methods, propensity score analysis, and emulated clinical trials using clinical databases hold promise for enhancing comparability between the study groups. Indeed, to comprehend the clinical efficacy of extracorporeal blood purification techniques in patients with sepsis, it is imperative to assemble homogeneous groups of patients receiving uniform treatments. Clinical strategies should be individualized, signaling the end of the "one size fits all" approach in sepsis therapy and the need for personalized treatments.
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Pol. Arch. Med. Wewn. · Dec 2024
ReviewDiagnosis of sepsis: which clinical and laboratory biomarkers are useful?
The quest for a definitive diagnostic tool for sepsis has spanned decades, yet it remains elusive. The diagnostic workup of sepsis is inherently complex, involving dozens of biochemical, hematologic, and immunologic parameters, alongside complex microbiological diagnostics. Over the past decade, the integration of omics technologies has further complicated this diagnostic landscape. ⋯ This work provides an overview of selected diagnostic biomarkers that are deemed readily applicable in routine clinical practice, extending applicability beyond highly specialized university hospitals. Verifying the reliability and clinical utility of diagnostic parameters generally takes several years, and often is more challenging in patients with sepsis, as compared with other cohorts, because of the complexity of this condition. Nevertheless, the integration of new technologies, the expanded use of bedside diagnostics, and advancements in omics technologies are propelling us toward the realization of personalized medicine and theranostics.
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Chinese medical journal · Dec 2024
ReviewEffect of endothelial responses on sepsis-associated organ dysfunction.
Sepsis-related organ dysfunction is associated with increased morbidity and mortality. Previous studies have found that the endothelium plays crucial roles in maintaining the vascular permeability during sepsis, as well as in regulating inflammation and thrombosis. During sepsis, endothelial cells may release cytokines, chemokines, and pro-coagulant factors, as well as express adhesion molecules. ⋯ However, excessive or prolonged endothelial activation can lead to impaired microcirculation, tissue hypoperfusion, and organ dysfunction. Given the structural and functional heterogeneity of endothelial cells in different organs, there are potential differences in endothelial responses by organ type, and the risk of organ damage may vary accordingly. This article reviews the endothelial response observed in sepsis and its effects on organ function, summarizes current progress in the development of therapeutic interventions targeting the endothelial response, and discusses future research directions to serve as a reference for researchers in the field.