SEPSIS: BASES MOLECULARES ACTUALES

Roberto A. Ferro Valdés; Francisco A. Medina Mosley

Enviado octubre 16, 2024

Publicado 2026-04-06

Artículos de Investigación

Vol. 18 Núm. 2 (2005): Revista Médico Científica

SEPSIS: BASES MOLECULARES ACTUALES

Roberto A. Ferro Valdés⁺⁻
Francisco A. Medina Mosley⁺⁻

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DOI: ND

Publicado: 2026-04-06

Derechos de autor 2024 Revista médico científica

Esta obra está bajo una licencia internacional Creative Commons Atribución-NoComercial-CompartirIgual 4.0.

Resumen

Por consenso, sepsis se define como la combinación de infección patológica y cambios fisiológicos conocidos colectivamente como síndrome de respuesta inflamatoria sistémica.

Los mecanismos fisiopatológicos de esta enfermedad se están comenzando a comprender mejor, y a partir de ellos se están desarrollando mejores formas para el diagnóstico y tratamiento.

En la siguiente revisión se expondrán los conceptos nuevos de esta patología que fundamentalmente se trata en las unidades de cuidados intensivos, pero que involucra todas las especialidades médicas desde neonatología hasta urología.

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Bone RC, Balk RA, Cerra FB, Dellinger RP, Fein AM, Knaus WA, et al. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Chest 1992;101:1644-55.
Wheeler AP, Bernard GR. Treating patients with severe sepsis. N Engl J Med 1999;340:207-14.
Hoyert DL, Arias E, Smith BL, Murphy SL, Kochanek KD. Deaths: final data for 1999. National Vital Statistics Reports. Vol. 49. No. 8. Hyattsville, Md.: National Center for Health Statistics, 2001.
Martin GS, Mannino DM, Eaton S, Moss M. The epidemiology of sepsis in the United States from 1979 through 2000. N Engl J Med 2003;348:1546-54.
Parrillo JE, Parker MM, Natanson C, Suffredini AF, Danner RL, Cunnion RE, et al. Septic shock in humans: advances in the understanding of pathogenesis, cardiovascular dysfunction, and therapy. Ann Intern Med 1990;113:227-42.
Angus DC, Linde-Zwirble WT, Lidicker J, Clermont G, Carcillo J, Pinsky MR. Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. Crit Care Med 2001;29:1303-10.
Thomas L. Germs. N Engl J Med 1972;287:553-5.
Stone R. Search for sepsis drugs goes on despite past failures. Science 1994;264:365-7.
Hagberg L, Briles DE, Eden CS. Evidence for separate genetic defects in C3H/HeJ and C3HeB/FeJ mice that affect susceptibility to gram-negative infections. J Immunol 1985;134:4118-22.
Hotchkiss RS, Swanson PE, Knudson CM, Chang KC, Cobb JP, Osborne DF, et al. Overexpression of Bcl-2 in transgenic mice decreases apoptosis and improves survival in sepsis. J Immunol 1999;162:4148-56.
Arbour NC, Lorenz E, Schulte BC, Zabner J, Kline JN, Jones M, et al. TLR 4 mutations are associated with endotoxin hyporesponsiveness in humans. Nat Genet 2000;25:187-91.
Lederer JA, Rodrick ML, Mannick JA. The effects of injury on the adaptive immune response. Shock 1999;11:153-9.
Oberholzer A, Oberholzer C, Moldawer LL. Sepsis syndromes: understanding the role of innate and acquired immunity. Shock 2001;16:83-96.
Heidecke CD, Hensler T, Weighardt H, Zantl N, Wagner H, Siewert JR, et al. Selective defects of T lymphocyte function in patients with lethal intraabdominal infection. Am J Surg 1999;178:288-92.
Pellegrini JD, De AK, Kodys K, Puyana JC, Furse RK, Miller-Graziano C. Relationships between T lymphocyte apoptosis and anergy following trauma. J Surg Res 2000;88:200-6.
Ayala A, Ertel W, Chaudry IH. Trauma-induced suppression of antigen presentation and expression of major histocompatibility class II antigen complex in leukocytes. Shock 1996;5:79-90.
Haslett C, Savill J. Why is apoptosis important to clinicians? BMJ 2001;322:1499-500.
Hotchkiss RS, Swanson PE, Freeman BD, Tinsley KW, Cobb JP, Matuschak GM, et al. Apoptotic cell death in patients with sepsis, shock, and multiple organ dysfunction. Crit Care Med 1999;27:1230-51.
Hotchkiss RS, Tinsley KW, Swanson PE, Schmieg Jr RE, Hui JJ, Chang KC, et al. Sepsis-induced apoptosis causes progressive profound depletion of B and CD4+ T lymphocytes in humans. J Immunol 2001;166:6952-63.
Hotchkiss RS, Tinsley KW, Swanson PE, Grayson MH, Osborne DF, Wagner, et al. Depletion of dendritic cells, but not macrophages, in patients with sepsis. J Immunol 2002;168:2493-500.
Fukuzuka K, Edwards CK III, Clare-Salzler M, Copeland EM III, Moldawer LL, Mozingo DW. Glucocorticoid-induced, caspase-dependent organ apoptosis early after burn injury. Am J Physiol Regul Integr Comp Physiol 2000;278:1005-18.
Savill J. Recognition and phagocytosis of cells undergoing apoptosis. Br Med Bull 1997;53:491-5.
Oberholzer C, Oberholzer A, Bahjat FR, Minter RM, Tannahill CL, Abouhamze A, et al. Targeted adenovirus-induced expression of IL-10 decreases thymic apoptosis and improves survival in murine sepsis. Proc Natl Acad Sci USA 2001;98:11503-8.
Hotchkiss RS, Chang KC, Swanson PE, Tinsley KW, Hui JJ, Klender P, et al. Caspase inhibitors improve survival in sepsis: a critical role of the lymphocyte. Nat Immunol 2000;1:496-501.
Weaver JGR, Rouse MS, Steckelberg JM, Badley AD. Improved survival in experimental sepsis with an orally administered inhibitor of apoptosis. FASEB J 2004;18:1185-91.
Bommhardt U, Chang KC, Swanson PE, Wagner TH, Tinsley KW, Karl IE, et al. Akt decreases lymphocyte apoptosis and improves survival in sepsis. J Immunol 2004;172:7583-91.
Munford RS. Severe sepsis and septic shock. In: Kasper DL, Braunwald E, Fauci AS, Hauser SL, Longo DL, Jameson JL. Harrison’s Principles of Internal Medicine. 16th edition Vol 2. United States of America: The McGraw-Hill Companies, Inc;2005:1606-12.
De Backer D, Creteur J, Preiser JC, Dubois MJ, Vincent JL. Microvascular blood flow is altered in patients with sepsis. Am J Respir Crit Care Med 2002;166:98-104.
Sayeed MM. Intestinal epithelial regenerative capacity: an "Achilles heel" in trauma/burn/sepsis injuries? Crit Care Med 2003;31:1864-6.
Wilson JX, Young GB. Progress in clinical neurosciences: sepsis-associated encephalopathy: evolving concepts. Can J Neurol Sci 2003;20:98-105.
Fowler DE, Wang P. The cardiovascular response in sepsis: proposed mechanisms of the beneficial effect of adrenomedullin and its binding protein. Int J Mol Med 2002;9:443-9.
Mann KG, Butenas S, Brummel K. The dynamics of thrombin formation. Arterioscler Thromb Vasc Biol 2003;1:17-25.
Esmon CT. The Protein C Pathway. Chest 2003;124:26-32.
Hotchkiss RS, Karl IE. The pathophysiology and treatment of sepsis. N Engl J Med 2003;348:138-50.
Sawyer DB, Loscalzo J. Myocardial hibernation: restorative or preterminal sleep? Circulation 2002;105:1517-9.
Khan AU, Delude RL, Han YY, Sappington PL, Han X, Carcillo JA, et al. Liposomal NAD(+) prevents diminished O(2) consumption by immunostimulated Caco-2 cells. Am J Physiol Lung Cell Mol Physiol 2002;282:1082-91.
Lancel S, Joulin O, Favory R. Ventricular myocyte caspases are directly responsible for endotoxin-induced cardiac dysfunction. Circulation 2005;111:2596-604.
Levy MM, Fink MP, Marshall JC, Abraham E, Angus D, Cook D, et al. 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Crit Care Med 2003;31:1250-6.
Marshall JC, Vincent JL, Fink MP, Cook DJ, Rubenfeld G, Foster D, et al. Measures, markers, and mediators: toward a staging system for clinical sepsis. A report of the Fifth Toronto Sepsis Roundtable, Toronto, Ontario, Canada. October 25-26, 2000. Crit Care Med 2003;31:1560-7.
Gomersall C. "PIRO." Department of Anaesthesia and Intensive Care. 29 Jun. 2005. University of Hong Kong. 15 Sept. 2005. http://www.aic.cuhk.edu.hk/web8/piro.htm.
Carrigan S, Scott G, Tabrizian M. Toward resolving the challenges of sepsis diagnosis. Clin Chem 2004;50:1301-14.
Blanco A, Solís G, Arranz E, Coto GD, Ramos A, Tellería J. Serum levels of CD14 in neonatal sepsis by Gram-positive and Gram-negative bacteria. Acta Paediatr 1996;85:728-32.
Blommendahl J, Janas M, Laine S, Miettinen A, Ashorn P. Comparison of procalcitonin with CRP and differential white blood cell count for diagnosis of culture-proven neonatal sepsis. Scand J Infect Dis 2002;34:620-2.
Bonac B, Derganc M, Wraber B, Hojker S. Interleukin-8 and procalcitonin in early diagnosis of early severe bacterial infection in critically ill neonates. Pflugers Arch 2000;440:72-4.
Chiesa C, Pellegrini G, Panero A, Osborn JF, Signore F, Assumma M, et al. C-Reactive protein, interleukin-6, and procalcitonin in the immediate postnatal period: influence of illness severity, risk status, antenatal and perinatal complications, and infection. Clin Chem 2003;49:60-8.
De Bont ES, Martens A, van Raan J, Samson G, Fetter WP, Okken A, et al. Diagnostic value of plasma levels of tumor necrosis factor alpha (TNF-alpha) and interleukin-6 (IL-6) in newborns with sepsis. Acta Paediatr 1994;83:696-9.
Doellner H, Arntzen KJ, Haereid PE, Aag S, Austgulen R. Interleukin-6 concentrations in neonates evaluated for sepsis. J Pediatr 1998;132:295-9.
Nupponen I, Andersson S, Jarvenpaa AI, Kautiainen H, Repo H. Neutrophil CD11b expressions and circulating interleukin-8 as diagnostic markers for early-onset neonatal sepsis. Pediatrics 2001;108:12.
Romagnoli C, Frezza S, Cingolani A, De Luca A, Puopolo M, De Carolis MP, et al. Plasma levels of interleukin-6 and interleukin-10 in preterm neonates evaluated for sepsis. Eur J Pediatr 2001;160:345-50.
Silveira RC, Procianoy RS. Evaluation of interleukin-6, tumour necrosis factor alpha and interleukin-1beta for early diagnosis of neonatal sepsis. Acta Paediatr 1999;88:647-50.
Balci C, Sungurtekin H, Gurses E, Sungurtekin U, Kaptanoglu B. Usefulness of procalcitonin for diagnosis of sepsis in the intensive care unit. Crit Care 2003;7:85-90.
Blairon L, Wittebole X, Laterre PF. Lipopolysaccharide-binding protein serum levels in patients with severe sepsis due to gram-positive and fungal infections. J Infect Dis 2003;187:287-91.
Casado-Flores J, Blanco-Quiros A, Asensio J, Arranz E, Garrote JA, Nieto M. Serum procalcitonin in children with suspected sepsis: a comparison with C-reactive protein and neutrophil count. Pediatr Crit Care Med 2003;4:190-5.
Cummings CJ, Sessler CN, Beall LD, Fisher BJ, Best AM, Fowler AA III. Soluble E-selectin levels in sepsis and critical illness. Correlation with infection and hemodynamic dysfunction. Am J Respir Crit Care Med 1997;156:431-7.
Han YY, Doughty LA, Kofos O, Sasser H, Carcillo JA. Procalcitonin is persistently increased among children with poor outcome from bacterial sepsis. Pediatr Crit Care Med 2003;4:21-5.
Harbarth S, Holeckova K, Froidevaux C, Pillet D, Ricou B, Grau GE, et al. Diagnostic value of procalcitonin, interleukin-6, and interleukin-8 in critically ill patients admitted with suspected sepsis. Am J Respir Crit Care Med 2001;164:396-402.
Muller B, Becker KL, Schachinger H, Rickenbacher PR, Huber PR, Zimmerli W, et al. Calcitonin precursors are reliable markers of sepsis in a medical intensive care unit. Crit Care Med
;28:977-83
Ruokonen E, Ilkka L, Niskanen M, Takala J. Procalcitonin and neopterin as indicators of infection in critically ill patients. Acta Anaesthesiol Scand 2002;46:398-404.
Suprin E, Camus C, Gacouin A, Le Tulzo Y, Lavoue S, Feuilli A, et al. Procalcitonin: a valuable indicator of infection in a medical ICU? Intensive Care Med 2000;26:1232-8.
Wakefield CH, Barclay GR, Fearon KC, Goldie AS, Ross JA, Grant IS, et al. Proinflammatory mediator activity, endogenous antagonists and the systemic inflammatory response in intra-abdominal sepsis. Scottish Sepsis Intervention Group. Br J Surg 1998;85:818-25.
Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med 1985;13:818-29.
Opal S. Tumor necrosis factor receptor expression on inflammatory cells in sepsis. Crit Care Med 1999;27:240-1.
Ashok K, Yadav C, Wilson G, Prasad PL, Menon PK. Polymerase chain reaction in rapid diagnosis of neonatal sepsis. Indian Pediatr 2005;42:681-5.
Jordan JA, Durso MB. Real-time polymerase chain reaction for detecting bacterial DNA directly from blood of neonates being evaluated for sepsis. Mol Diagn 2005;7:575-81.
Eigner U, Weizenegger M, Fahr AM, Witte W. Evaluation of a rapid direct assay for identification of bacteria and the mecA and van genes from positive-testing blood cultures. J Clin Microbiol 2005;43:5256-62.
Spanjaard L, Kuijper EJ, Dankert J. Clinical comparison of two commercial blood culture systems. Eur J Clin Microbiol Infect Dis 2000;19:881-5.
Wilson ML, Mirrett S, McDonald LC, Weinstein MP, Fune J, Reller LB. Controlled clinical comparison of bioMérieux VITAL and BACTEC NR-660 blood culture systems for detection of bacteremia and fungemia in adults. J Clin Microbiol 1999;37:1709-13.
Mort T, Yeston NS. The relationship of premortem diagnoses and postmortem findings in a surgical intensive care unit. Crit Care Med 1999;27:299-303.
Blosser SA, Zimmerman HE, Stauffer JL. Do autopsies of critically ill patients reveal important findings that were clinically undetected? Crit Care Med 1998;26:1332-6.
Harbarth S, Garbino J, Pugin J, Romand JA, Lew D, Pillet D. Inappropriate initial antimicrobial therapy and its effect on survival in a clinical trial of immunomodulating therapy for severe sepsis. Am J Med 2003;115:529-35.
Bernard GR, Vincent JL, Laterre PF, LaRosa SP, Dhainaut JF, Lopez-Rodriguez A, et al. Efficacy and safety of recombinant human activated protein C for severe sepsis. N Engl J Med 2001;344:699-709.
Abraham E, Laterre PF, Garg R, Levy H, Talwar D, Trzaskoma BL, et al. Drotrecogin alfa (activated) for adults with severe sepsis and a low risk of death. N Engl J Med 2005;353:1332-41.
Keh D, Boehnke T, Weber-Cartens S, Schulz C, Ahlers O, Bercker S, et al. Immunologic and hemodynamic effects of low-dose hydrocortisone in septic shock. A double-blind, randomized placebo-controlled crossover study. Am J Respir Crit Care Med 2003;167:512-20.
Annane D. Corticosteroids for septic shock. Crit Care Med 2001;29:117-20.
McCombs CC, de Shazo RD. Immune system disorders. In: Speight TM, Holford NHG, eds. Drug Treatment, 4th edn. Chester: Adis International Ltd, 1997;1304.
Lefering R, Neugebauer EAM. Steroid controversy in sepsis and septic shock: a meta-analysis. Crit Care Med 1995;23:1430-9.
Cronin L, Cook DJ, Carlet J, Heyland DK, King D, Lansang MA, et al. Corticosteroids treatment for sepsis: a critical appraisal and meta-analysis of the literature. Crit Care Med 1995;23:1430-9.
Annane D, Sebille V, Charpentier C, Bollaert PE, Francois B, Korach JM, et al. Effect of treatment with low doses of hydrocortisone and fludrocortisone on mortality in patients with septic shock. JAMA 2002;288:862-71.
Annane D. Glucocorticoids in the treatment of severe sepsis and septic shock. Curr Opin Crit Care 2005;11:449-53.
Keh D, Goodman S, Sprung CL. Corticosteroid therapy in patients with severe sepsis and septic shock. Semin Respir Crit Care Med 2004;25:713-9.
Cooper MS, Stewart PM. Corticosteroid insufficiency in acutely ill patients. N Engl J Med 2003;348:727-34.
De Vriese A. Prevention and treatment of acute renal failure in sepsis. J Am Soc Nephrol 2003;14:792-805.
Opal SM, Cross AS, Jhung JW, Young LD, Palardy JE, Parejo NA, et al. Potential hazards of combination immunotherapy in the treatment of experimental septic shock. J Infect Dis 1996;173:1415-21.
Reinhart K, Karzai W. Anti-tumor necrosis factor therapy in sepsis: update on clinical trials and lessons learned. Crit Care Med 2001;29:121-5.
Eichacker PO, Parent C, Kalil A, Esposito C, Cui X, Banks SM, et al. Risk and the efficacy of anti-inflammatory agents. Am J Respir Crit Care Med 2002;166:1197-205.
Van den Berghe G, Wouters P, Weekers F, Verwaest C, Bruyninckx F, Schetz M, et al. Intensive insulin therapy in critically ill patients. N Engl J Med 2001;345:1359-67.
Van den Berghe G, Wouters PJ, Bouillon R, Weekers F, Verwaest C, Schetz M, et al. Outcome benefit of intensive insulin therapy in the critically ill: insulin dose versus glycemic control. Crit Care Med 2003;31:359-66.
Gao F, Gao E, Yue TL, Ohlstein EH, López BL, Christopher TA, et al. Nitric oxide mediates the antiapoptotic effect of insulin in myocardial ischemia-reperfusion: the roles of PI3-kinase, Akt, and endothelial nitric oxide synthase phosphorylation. Circulation 2002;105:1497-502.
Siegel JP. Assessing the use of activated protein C in the treatment of severe sepsis. N Engl J Med 2002;347:1030-4.
Gilbert D, Moellering R, Eliopoulos G, Sande M. The Sanford Guide to Antimicrobial Therapy. 13th edition. Antimicrobial Therapy, Inc. 2004:41.

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[1] Bone RC, Balk RA, Cerra FB, Dellinger RP, Fein AM, Knaus WA, et al. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Chest 1992;101:1644-55.

[2] Wheeler AP, Bernard GR. Treating patients with severe sepsis. N Engl J Med 1999;340:207-14.

[3] Hoyert DL, Arias E, Smith BL, Murphy SL, Kochanek KD. Deaths: final data for 1999. National Vital Statistics Reports. Vol. 49. No. 8. Hyattsville, Md.: National Center for Health Statistics, 2001.

[4] Martin GS, Mannino DM, Eaton S, Moss M. The epidemiology of sepsis in the United States from 1979 through 2000. N Engl J Med 2003;348:1546-54.

[5] Parrillo JE, Parker MM, Natanson C, Suffredini AF, Danner RL, Cunnion RE, et al. Septic shock in humans: advances in the understanding of pathogenesis, cardiovascular dysfunction, and therapy. Ann Intern Med 1990;113:227-42.

[6] Angus DC, Linde-Zwirble WT, Lidicker J, Clermont G, Carcillo J, Pinsky MR. Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. Crit Care Med 2001;29:1303-10.

[7] Thomas L. Germs. N Engl J Med 1972;287:553-5.

[8] Stone R. Search for sepsis drugs goes on despite past failures. Science 1994;264:365-7.

[9] Hagberg L, Briles DE, Eden CS. Evidence for separate genetic defects in C3H/HeJ and C3HeB/FeJ mice that affect susceptibility to gram-negative infections. J Immunol 1985;134:4118-22.

[10] Hotchkiss RS, Swanson PE, Knudson CM, Chang KC, Cobb JP, Osborne DF, et al. Overexpression of Bcl-2 in transgenic mice decreases apoptosis and improves survival in sepsis. J Immunol 1999;162:4148-56.

[11] Arbour NC, Lorenz E, Schulte BC, Zabner J, Kline JN, Jones M, et al. TLR 4 mutations are associated with endotoxin hyporesponsiveness in humans. Nat Genet 2000;25:187-91.

[12] Lederer JA, Rodrick ML, Mannick JA. The effects of injury on the adaptive immune response. Shock 1999;11:153-9.

[13] Oberholzer A, Oberholzer C, Moldawer LL. Sepsis syndromes: understanding the role of innate and acquired immunity. Shock 2001;16:83-96.

[14] Heidecke CD, Hensler T, Weighardt H, Zantl N, Wagner H, Siewert JR, et al. Selective defects of T lymphocyte function in patients with lethal intraabdominal infection. Am J Surg 1999;178:288-92.

[15] Pellegrini JD, De AK, Kodys K, Puyana JC, Furse RK, Miller-Graziano C. Relationships between T lymphocyte apoptosis and anergy following trauma. J Surg Res 2000;88:200-6.

[16] Ayala A, Ertel W, Chaudry IH. Trauma-induced suppression of antigen presentation and expression of major histocompatibility class II antigen complex in leukocytes. Shock 1996;5:79-90.

[17] Haslett C, Savill J. Why is apoptosis important to clinicians? BMJ 2001;322:1499-500.

[18] Hotchkiss RS, Swanson PE, Freeman BD, Tinsley KW, Cobb JP, Matuschak GM, et al. Apoptotic cell death in patients with sepsis, shock, and multiple organ dysfunction. Crit Care Med 1999;27:1230-51.

[19] Hotchkiss RS, Tinsley KW, Swanson PE, Schmieg Jr RE, Hui JJ, Chang KC, et al. Sepsis-induced apoptosis causes progressive profound depletion of B and CD4+ T lymphocytes in humans. J Immunol 2001;166:6952-63.

[20] Hotchkiss RS, Tinsley KW, Swanson PE, Grayson MH, Osborne DF, Wagner, et al. Depletion of dendritic cells, but not macrophages, in patients with sepsis. J Immunol 2002;168:2493-500.

[21] Fukuzuka K, Edwards CK III, Clare-Salzler M, Copeland EM III, Moldawer LL, Mozingo DW. Glucocorticoid-induced, caspase-dependent organ apoptosis early after burn injury. Am J Physiol Regul Integr Comp Physiol 2000;278:1005-18.

[22] Savill J. Recognition and phagocytosis of cells undergoing apoptosis. Br Med Bull 1997;53:491-5.

[23] Oberholzer C, Oberholzer A, Bahjat FR, Minter RM, Tannahill CL, Abouhamze A, et al. Targeted adenovirus-induced expression of IL-10 decreases thymic apoptosis and improves survival in murine sepsis. Proc Natl Acad Sci USA 2001;98:11503-8.

[24] Hotchkiss RS, Chang KC, Swanson PE, Tinsley KW, Hui JJ, Klender P, et al. Caspase inhibitors improve survival in sepsis: a critical role of the lymphocyte. Nat Immunol 2000;1:496-501.

[25] Weaver JGR, Rouse MS, Steckelberg JM, Badley AD. Improved survival in experimental sepsis with an orally administered inhibitor of apoptosis. FASEB J 2004;18:1185-91.

[26] Bommhardt U, Chang KC, Swanson PE, Wagner TH, Tinsley KW, Karl IE, et al. Akt decreases lymphocyte apoptosis and improves survival in sepsis. J Immunol 2004;172:7583-91.

[27] Munford RS. Severe sepsis and septic shock. In: Kasper DL, Braunwald E, Fauci AS, Hauser SL, Longo DL, Jameson JL. Harrison’s Principles of Internal Medicine. 16th edition Vol 2. United States of America: The McGraw-Hill Companies, Inc;2005:1606-12.

[28] De Backer D, Creteur J, Preiser JC, Dubois MJ, Vincent JL. Microvascular blood flow is altered in patients with sepsis. Am J Respir Crit Care Med 2002;166:98-104.

[29] Sayeed MM. Intestinal epithelial regenerative capacity: an "Achilles heel" in trauma/burn/sepsis injuries? Crit Care Med 2003;31:1864-6.

[30] Wilson JX, Young GB. Progress in clinical neurosciences: sepsis-associated encephalopathy: evolving concepts. Can J Neurol Sci 2003;20:98-105.

[31] Fowler DE, Wang P. The cardiovascular response in sepsis: proposed mechanisms of the beneficial effect of adrenomedullin and its binding protein. Int J Mol Med 2002;9:443-9.

[32] Mann KG, Butenas S, Brummel K. The dynamics of thrombin formation. Arterioscler Thromb Vasc Biol 2003;1:17-25.

[33] Esmon CT. The Protein C Pathway. Chest 2003;124:26-32.

[34] Hotchkiss RS, Karl IE. The pathophysiology and treatment of sepsis. N Engl J Med 2003;348:138-50.

[35] Sawyer DB, Loscalzo J. Myocardial hibernation: restorative or preterminal sleep? Circulation 2002;105:1517-9.

[36] Khan AU, Delude RL, Han YY, Sappington PL, Han X, Carcillo JA, et al. Liposomal NAD(+) prevents diminished O(2) consumption by immunostimulated Caco-2 cells. Am J Physiol Lung Cell Mol Physiol 2002;282:1082-91.

[37] Lancel S, Joulin O, Favory R. Ventricular myocyte caspases are directly responsible for endotoxin-induced cardiac dysfunction. Circulation 2005;111:2596-604.

[38] Levy MM, Fink MP, Marshall JC, Abraham E, Angus D, Cook D, et al. 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Crit Care Med 2003;31:1250-6.

[39] Marshall JC, Vincent JL, Fink MP, Cook DJ, Rubenfeld G, Foster D, et al. Measures, markers, and mediators: toward a staging system for clinical sepsis. A report of the Fifth Toronto Sepsis Roundtable, Toronto, Ontario, Canada. October 25-26, 2000. Crit Care Med 2003;31:1560-7.

[40] Gomersall C. "PIRO." Department of Anaesthesia and Intensive Care. 29 Jun. 2005. University of Hong Kong. 15 Sept. 2005. http://www.aic.cuhk.edu.hk/web8/piro.htm.

[41] Carrigan S, Scott G, Tabrizian M. Toward resolving the challenges of sepsis diagnosis. Clin Chem 2004;50:1301-14.

[42] Blanco A, Solís G, Arranz E, Coto GD, Ramos A, Tellería J. Serum levels of CD14 in neonatal sepsis by Gram-positive and Gram-negative bacteria. Acta Paediatr 1996;85:728-32.

[43] Blommendahl J, Janas M, Laine S, Miettinen A, Ashorn P. Comparison of procalcitonin with CRP and differential white blood cell count for diagnosis of culture-proven neonatal sepsis. Scand J Infect Dis 2002;34:620-2.

[44] Bonac B, Derganc M, Wraber B, Hojker S. Interleukin-8 and procalcitonin in early diagnosis of early severe bacterial infection in critically ill neonates. Pflugers Arch 2000;440:72-4.

[45] Chiesa C, Pellegrini G, Panero A, Osborn JF, Signore F, Assumma M, et al. C-Reactive protein, interleukin-6, and procalcitonin in the immediate postnatal period: influence of illness severity, risk status, antenatal and perinatal complications, and infection. Clin Chem 2003;49:60-8.

[46] De Bont ES, Martens A, van Raan J, Samson G, Fetter WP, Okken A, et al. Diagnostic value of plasma levels of tumor necrosis factor alpha (TNF-alpha) and interleukin-6 (IL-6) in newborns with sepsis. Acta Paediatr 1994;83:696-9.

[47] Doellner H, Arntzen KJ, Haereid PE, Aag S, Austgulen R. Interleukin-6 concentrations in neonates evaluated for sepsis. J Pediatr 1998;132:295-9.

[48] Nupponen I, Andersson S, Jarvenpaa AI, Kautiainen H, Repo H. Neutrophil CD11b expressions and circulating interleukin-8 as diagnostic markers for early-onset neonatal sepsis. Pediatrics 2001;108:12.

[49] Romagnoli C, Frezza S, Cingolani A, De Luca A, Puopolo M, De Carolis MP, et al. Plasma levels of interleukin-6 and interleukin-10 in preterm neonates evaluated for sepsis. Eur J Pediatr 2001;160:345-50.

[50] Silveira RC, Procianoy RS. Evaluation of interleukin-6, tumour necrosis factor alpha and interleukin-1beta for early diagnosis of neonatal sepsis. Acta Paediatr 1999;88:647-50.

[51] Balci C, Sungurtekin H, Gurses E, Sungurtekin U, Kaptanoglu B. Usefulness of procalcitonin for diagnosis of sepsis in the intensive care unit. Crit Care 2003;7:85-90.

[52] Blairon L, Wittebole X, Laterre PF. Lipopolysaccharide-binding protein serum levels in patients with severe sepsis due to gram-positive and fungal infections. J Infect Dis 2003;187:287-91.

[53] Casado-Flores J, Blanco-Quiros A, Asensio J, Arranz E, Garrote JA, Nieto M. Serum procalcitonin in children with suspected sepsis: a comparison with C-reactive protein and neutrophil count. Pediatr Crit Care Med 2003;4:190-5.

[54] Cummings CJ, Sessler CN, Beall LD, Fisher BJ, Best AM, Fowler AA III. Soluble E-selectin levels in sepsis and critical illness. Correlation with infection and hemodynamic dysfunction. Am J Respir Crit Care Med 1997;156:431-7.

[55] Han YY, Doughty LA, Kofos O, Sasser H, Carcillo JA. Procalcitonin is persistently increased among children with poor outcome from bacterial sepsis. Pediatr Crit Care Med 2003;4:21-5.

[56] Harbarth S, Holeckova K, Froidevaux C, Pillet D, Ricou B, Grau GE, et al. Diagnostic value of procalcitonin, interleukin-6, and interleukin-8 in critically ill patients admitted with suspected sepsis. Am J Respir Crit Care Med 2001;164:396-402.

[57] Muller B, Becker KL, Schachinger H, Rickenbacher PR, Huber PR, Zimmerli W, et al. Calcitonin precursors are reliable markers of sepsis in a medical intensive care unit. Crit Care Med

[58] ;28:977-83

[59] Ruokonen E, Ilkka L, Niskanen M, Takala J. Procalcitonin and neopterin as indicators of infection in critically ill patients. Acta Anaesthesiol Scand 2002;46:398-404.

[60] Suprin E, Camus C, Gacouin A, Le Tulzo Y, Lavoue S, Feuilli A, et al. Procalcitonin: a valuable indicator of infection in a medical ICU? Intensive Care Med 2000;26:1232-8.

[61] Wakefield CH, Barclay GR, Fearon KC, Goldie AS, Ross JA, Grant IS, et al. Proinflammatory mediator activity, endogenous antagonists and the systemic inflammatory response in intra-abdominal sepsis. Scottish Sepsis Intervention Group. Br J Surg 1998;85:818-25.

[62] Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med 1985;13:818-29.

[63] Opal S. Tumor necrosis factor receptor expression on inflammatory cells in sepsis. Crit Care Med 1999;27:240-1.

[64] Ashok K, Yadav C, Wilson G, Prasad PL, Menon PK. Polymerase chain reaction in rapid diagnosis of neonatal sepsis. Indian Pediatr 2005;42:681-5.

[65] Jordan JA, Durso MB. Real-time polymerase chain reaction for detecting bacterial DNA directly from blood of neonates being evaluated for sepsis. Mol Diagn 2005;7:575-81.

[66] Eigner U, Weizenegger M, Fahr AM, Witte W. Evaluation of a rapid direct assay for identification of bacteria and the mecA and van genes from positive-testing blood cultures. J Clin Microbiol 2005;43:5256-62.

[67] Spanjaard L, Kuijper EJ, Dankert J. Clinical comparison of two commercial blood culture systems. Eur J Clin Microbiol Infect Dis 2000;19:881-5.

[68] Wilson ML, Mirrett S, McDonald LC, Weinstein MP, Fune J, Reller LB. Controlled clinical comparison of bioMérieux VITAL and BACTEC NR-660 blood culture systems for detection of bacteremia and fungemia in adults. J Clin Microbiol 1999;37:1709-13.

[69] Mort T, Yeston NS. The relationship of premortem diagnoses and postmortem findings in a surgical intensive care unit. Crit Care Med 1999;27:299-303.

[70] Blosser SA, Zimmerman HE, Stauffer JL. Do autopsies of critically ill patients reveal important findings that were clinically undetected? Crit Care Med 1998;26:1332-6.

[71] Harbarth S, Garbino J, Pugin J, Romand JA, Lew D, Pillet D. Inappropriate initial antimicrobial therapy and its effect on survival in a clinical trial of immunomodulating therapy for severe sepsis. Am J Med 2003;115:529-35.

[72] Bernard GR, Vincent JL, Laterre PF, LaRosa SP, Dhainaut JF, Lopez-Rodriguez A, et al. Efficacy and safety of recombinant human activated protein C for severe sepsis. N Engl J Med 2001;344:699-709.

[73] Abraham E, Laterre PF, Garg R, Levy H, Talwar D, Trzaskoma BL, et al. Drotrecogin alfa (activated) for adults with severe sepsis and a low risk of death. N Engl J Med 2005;353:1332-41.

[74] Keh D, Boehnke T, Weber-Cartens S, Schulz C, Ahlers O, Bercker S, et al. Immunologic and hemodynamic effects of low-dose hydrocortisone in septic shock. A double-blind, randomized placebo-controlled crossover study. Am J Respir Crit Care Med 2003;167:512-20.

[75] Annane D. Corticosteroids for septic shock. Crit Care Med 2001;29:117-20.

[76] McCombs CC, de Shazo RD. Immune system disorders. In: Speight TM, Holford NHG, eds. Drug Treatment, 4th edn. Chester: Adis International Ltd, 1997;1304.

[77] Lefering R, Neugebauer EAM. Steroid controversy in sepsis and septic shock: a meta-analysis. Crit Care Med 1995;23:1430-9.

[78] Cronin L, Cook DJ, Carlet J, Heyland DK, King D, Lansang MA, et al. Corticosteroids treatment for sepsis: a critical appraisal and meta-analysis of the literature. Crit Care Med 1995;23:1430-9.

[79] Annane D, Sebille V, Charpentier C, Bollaert PE, Francois B, Korach JM, et al. Effect of treatment with low doses of hydrocortisone and fludrocortisone on mortality in patients with septic shock. JAMA 2002;288:862-71.

[80] Annane D. Glucocorticoids in the treatment of severe sepsis and septic shock. Curr Opin Crit Care 2005;11:449-53.

[81] Keh D, Goodman S, Sprung CL. Corticosteroid therapy in patients with severe sepsis and septic shock. Semin Respir Crit Care Med 2004;25:713-9.

[82] Cooper MS, Stewart PM. Corticosteroid insufficiency in acutely ill patients. N Engl J Med 2003;348:727-34.

[83] De Vriese A. Prevention and treatment of acute renal failure in sepsis. J Am Soc Nephrol 2003;14:792-805.

[84] Opal SM, Cross AS, Jhung JW, Young LD, Palardy JE, Parejo NA, et al. Potential hazards of combination immunotherapy in the treatment of experimental septic shock. J Infect Dis 1996;173:1415-21.

[85] Reinhart K, Karzai W. Anti-tumor necrosis factor therapy in sepsis: update on clinical trials and lessons learned. Crit Care Med 2001;29:121-5.

[86] Eichacker PO, Parent C, Kalil A, Esposito C, Cui X, Banks SM, et al. Risk and the efficacy of anti-inflammatory agents. Am J Respir Crit Care Med 2002;166:1197-205.

[87] Van den Berghe G, Wouters P, Weekers F, Verwaest C, Bruyninckx F, Schetz M, et al. Intensive insulin therapy in critically ill patients. N Engl J Med 2001;345:1359-67.

[88] Van den Berghe G, Wouters PJ, Bouillon R, Weekers F, Verwaest C, Schetz M, et al. Outcome benefit of intensive insulin therapy in the critically ill: insulin dose versus glycemic control. Crit Care Med 2003;31:359-66.

[89] Gao F, Gao E, Yue TL, Ohlstein EH, López BL, Christopher TA, et al. Nitric oxide mediates the antiapoptotic effect of insulin in myocardial ischemia-reperfusion: the roles of PI3-kinase, Akt, and endothelial nitric oxide synthase phosphorylation. Circulation 2002;105:1497-502.

[90] Siegel JP. Assessing the use of activated protein C in the treatment of severe sepsis. N Engl J Med 2002;347:1030-4.

[91] Gilbert D, Moellering R, Eliopoulos G, Sande M. The Sanford Guide to Antimicrobial Therapy. 13th edition. Antimicrobial Therapy, Inc. 2004:41.

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