Gut-origin sepsis in the critically ill patient: pathophysiology and treatment

Infection
Stelios F AssimakopoulosCharalambos A Gogos

Abstract

Gut permeability is increased in critically ill patients, and associated with the development of the systemic inflammatory response syndrome and multiple organ dysfunction syndrome (MODS). The pathogenetic link(s) and potential therapies are an area of intense research over the last decades. We thoroughly reviewed the literature on gut-origin sepsis and MODS in critically ill patients, with emphasis on the implicated pathophysiological mechanisms and therapeutic interventions. Intestinal barrier failure leading to systemic bacterial translocation associated with MODS was the predominant pathophysiological theory for several years. However, clinical studies with critically ill patients failed to provide the evidence of systemic spread of gut-derived bacteria and/or their products as a cause of MODS. Newer experimental data highlight the role of the mesenteric lymph as a carrier of gut-derived danger-associated molecular patterns (DAMPs) to the lung and the systemic circulation. These substances are recognized by pattern recognition receptor-bearing cells in diverse tissues and promote proinflammatory pathways and the development MODS. Therefore, the gut becomes a pivotal proinflammatory organ, driving the systemic inflammatory r...Continue Reading

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Citations

Jun 4, 2019·Inflammation Research : Official Journal of the European Histamine Research Society ... [et Al.]·Felix Nnaemeka Ugwu, Jeffery Ho
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Aug 28, 2021·World Journal of Gastroenterology : WJG·Jia-Kui SunXin-Wei Mu

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