Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Critical Care
Published in: Critical Care 1/2017

Open Access 01-12-2017 | Editorial

Towards precision medicine for sepsis patients

Authors: Peter Pickkers, Matthijs Kox

Published in: Critical Care | Issue 1/2017

Login to get access

Excerpt

Over the last decade it has become clear that the immunological response and clinical course in sepsis patients is too complex to simply regard it as ‘hyperinflammation-induced organ failure’. In contrast to the previous belief that patients mainly suffer from an exaggerated pro-inflammatory response, it has now become evident that a pro- and anti-inflammatory response are mounted simultaneously [1, 2]. Whether pro-inflammation or anti-inflammation is the overruling immune response may differ between patients and evolve over time in an individual patient [2], and this may explain why all previous clinical studies in sepsis patients using interventions to attenuate the immune response are negative [3]. Greater appreciation for the role of the dysregulated immune response is represented in the new definition of sepsis [4], defining sepsis as a life-threatening organ dysfunction caused by a dysregulated host response to infection. …
Literature
1.
2.
Leentjens J, Kox M, van der Hoeven JG, Netea MG, Pickkers P. Immunotherapy for the adjunctive treatment of sepsis: from immunosuppression to immunostimulation. Time for a paradigm change? Am J Respir Crit Care Med. 2013;187(12):1287–93.CrossRefPubMed
3.
4.
Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, Bellomo R, Bernard GR, Chiche JD, Coopersmith CM, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016;315(8):801–10.CrossRefPubMedPubMedCentral
5.
Opal SM, Fisher Jr CJ, Dhainaut JF, Vincent JL, Brase R, Lowry SF, Sadoff JC, Slotman GJ, Levy H, Balk RA, et al. Confirmatory interleukin-1 receptor antagonist trial in severe sepsis: a phase III, randomized, double-blind, placebo-controlled, multicenter trial. The Interleukin-1 Receptor Antagonist Sepsis Investigator Group. Crit Care Med. 1997;25(7):1115–24.CrossRefPubMed
6.
Shakoory B, Carcillo JA, Chatham WW, Amdur RL, Zhao H, Dinarello CA, Cron RQ, Opal SM. Interleukin-1 receptor blockade is associated with reduced mortality in sepsis patients with features of macrophage activation syndrome: reanalysis of a prior phase III trial. Crit Care Med. 2016;44(2):275–81.CrossRefPubMed
7.
Otto GP, Sossdorf M, Claus RA, Rodel J, Menge K, Reinhart K, Bauer M, Riedemann NC. The late phase of sepsis is characterized by an increased microbiological burden and death rate. Crit Care. 2011;15(4):R183.CrossRefPubMedPubMedCentral
8.
Walton AH, Muenzer JT, Rasche D, Boomer JS, Sato B, Brownstein BH, Pachot A, Brooks TL, Deych E, Shannon WD, et al. Reactivation of multiple viruses in patients with sepsis. PLoS One. 2014;9(2), e98819.CrossRefPubMedPubMedCentral
9.
Boomer JS, To K, Chang KC, Takasu O, Osborne DF, Walton AH, Bricker TL. Jarman 2nd SD, Kreisel D, Krupnick AS, et al. Immunosuppression in patients who die of sepsis and multiple organ failure. JAMA. 2011;306(23):2594–605.CrossRefPubMedPubMedCentral
10.
Cheng SC, Scicluna BP, Arts RJ, Gresnigt MS, Lachmandas E, Giamarellos-Bourboulis EJ, Kox M, Manjeri GR, Wagenaars JA, Cremer OL, et al. Broad defects in the energy metabolism of leukocytes underlie immunoparalysis in sepsis. Nat Immunol. 2016;17(4):406–13.CrossRefPubMed
11.
Shao R, Fang Y, Yu H, Zhao L, Jiang Z, Li CS. Monocyte programmed death ligand-1 expression after 3–4 days of sepsis is associated with risk stratification and mortality in septic patients: a prospective cohort study. Crit Care. 2016;20(1):124.CrossRefPubMedPubMedCentral
12.
Patera AC, Drewry AM, Chang K, Beiter ER, Osborne D, Hotchkiss RS. Frontline Science: defects in immune function in patients with sepsis are associated with PD-1 or PD-L1 expression and can be restored by antibodies targeting PD-1 or PD-L1. J Leukoc Biol. 2016.
13.
14.
Drewry AM, Ablordeppey EA, Murray ET, Beiter ER, Walton AH, Hall MW, Hotchkiss RS. Comparison of monocyte human leukocyte antigen-DR expression and stimulated tumor necrosis factor alpha production as outcome predictors in severe sepsis: a prospective observational study. Crit Care. 2016;20(1):334.CrossRefPubMedPubMedCentral
15.
Meisel C, Schefold JC, Pschowski R, Baumann T, Hetzger K, Gregor J, Weber-Carstens S, Hasper D, Keh D, Zuckermann H, et al. Granulocyte-macrophage colony-stimulating factor to reverse sepsis-associated immunosuppression: a double-blind, randomized, placebo-controlled multicenter trial. Am J Respir Crit Care Med. 2009;180(7):640–8.CrossRefPubMed
Metadata
Title
Towards precision medicine for sepsis patients
Authors
Peter Pickkers
Matthijs Kox
Publication date
01-12-2017
Publisher
BioMed Central
Published in
Critical Care / Issue 1/2017
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/s13054-016-1583-z

Other articles of this Issue 1/2017

Critical Care 1/2017 Go to the issue

Research

Plasma metabolomics for the diagnosis and prognosis of H1N1 influenza pneumonia

Editorial

Iatrogenic hemodilution: a possible cause for avoidable blood transfusions?

Research

Influence of low-flow time on survival after extracorporeal cardiopulmonary resuscitation (eCPR)

Research

Aerosol delivery during invasive mechanical ventilation: a systematic review

Research

Can calculation of energy expenditure based on CO2 measurements replace indirect calorimetry?

Research

Selepressin, a novel selective vasopressin V1A agonist, is an effective substitute for norepinephrine in a phase IIa randomized, placebo-controlled trial in septic shock patients