“…The 2021 Surviving Sepsis Campaign (SSC) guidelines include several new or revised recommendations on early sepsis management, as well as a new set of recommendations on peri-discharge management to enhance long-term outcomes from sepsis. There were several important aspects of management for which the panel could not provide a recommendation (e.g., ongoing fluid management strategy and early cognitive rehabilitation), underscoring the need for further research to guide care for sepsis [ 38 – 40 ].…”
The Surviving Sepsis Campaign (SSC) International Guidelines for the Management of Sepsis and Septic Shock provide recommendations on the care of hospitalized adult patients with (or at risk for) sepsis. This review discusses what is new or different in the 2021 SSC adult sepsis guidelines compared to 2016. The guidelines include new weak recommendations for use of balanced fluid over saline 0.9%, use of intravenous corticosteroids for septic shock when there is ongoing vasopressor requirement, and peripheral initiation of intravenous vasopressors over delaying initiation in order to obtain central venous access. As before, there is a strong recommendation to initiate antimicrobials within 1 h of sepsis and septic shock, but there are now additional recommendations when the diagnosis is uncertain. The recommendation for initial fluid resuscitation in septic shock of 30 mL/kg crystalloid has been downgraded from strong to weak. Finally, there are 12 new recommendations addressing long-term outcomes from sepsis, including strong recommendations to screen for economic and social support and to make referrals for follow-up where available; use shared decision-making in post-intensive care unit (ICU) and hospital discharge planning; reconcile medications at both ICU and hospital discharge; provide information about sepsis and its sequelae in written and verbal hospital discharge summary; and to provide assessment and follow-up for physical, cognitive, and emotional problems after hospital discharge.
“…The 2021 Surviving Sepsis Campaign (SSC) guidelines include several new or revised recommendations on early sepsis management, as well as a new set of recommendations on peri-discharge management to enhance long-term outcomes from sepsis. There were several important aspects of management for which the panel could not provide a recommendation (e.g., ongoing fluid management strategy and early cognitive rehabilitation), underscoring the need for further research to guide care for sepsis [ 38 – 40 ].…”
The Surviving Sepsis Campaign (SSC) International Guidelines for the Management of Sepsis and Septic Shock provide recommendations on the care of hospitalized adult patients with (or at risk for) sepsis. This review discusses what is new or different in the 2021 SSC adult sepsis guidelines compared to 2016. The guidelines include new weak recommendations for use of balanced fluid over saline 0.9%, use of intravenous corticosteroids for septic shock when there is ongoing vasopressor requirement, and peripheral initiation of intravenous vasopressors over delaying initiation in order to obtain central venous access. As before, there is a strong recommendation to initiate antimicrobials within 1 h of sepsis and septic shock, but there are now additional recommendations when the diagnosis is uncertain. The recommendation for initial fluid resuscitation in septic shock of 30 mL/kg crystalloid has been downgraded from strong to weak. Finally, there are 12 new recommendations addressing long-term outcomes from sepsis, including strong recommendations to screen for economic and social support and to make referrals for follow-up where available; use shared decision-making in post-intensive care unit (ICU) and hospital discharge planning; reconcile medications at both ICU and hospital discharge; provide information about sepsis and its sequelae in written and verbal hospital discharge summary; and to provide assessment and follow-up for physical, cognitive, and emotional problems after hospital discharge.
“…This requires sepsis to be included in national research and health care agendas, additional funding and strengthening of research capacities, and the support of global initiatives and programs, e.g., by linking sepsis epidemiology research with existing programs like on antimicrobial resistance or patient safety (Fig. 2 ; [ 33 ]). In Germany, this comes together with the call to foster the use of digital health care data.…”
Section: Future Directions Of Sepsis Epidemiology Researchmentioning
confidence: 99%
“… Fig. 2 Global short- and long-term priorities for sepsis epidemiology research, modified based on the outcomes of the Technical Expert Meeting on Methodology for Sepsis Epidemiology Research [ 33 ] …”
Section: Future Directions Of Sepsis Epidemiology Researchmentioning
Background
Sepsis is one of the most frequent causes of death worldwide, but the recording of population-based epidemiology is challenging, which is why reliable data on sepsis incidence and mortality are only available in a few, mostly highly-resourced countries.
Objective
The aim of this narrative review is to provide an overview of sepsis epidemiology worldwide and in Germany based on current literature, to identify challenges in this research area, and to give an outlook on future developments.
Materials and methods
Selective literature review. PubMed and Google Scholar were searched for current literature. The results were processed narratively.
Results
Based on modeling studies or meta-analyses of prospective studies, global annual sepsis incidence was found to be 276–678/100,000 persons. Case fatality ranged from 22.5 to 26.7%. However, current data sources have several limitations, as administrative data of selected individual countries—mostly with high income—were used as their basis. In these administrative data, sepsis is captured with limited validity. Prospective studies using clinical data often have limited comparability or lack population reference.
Conclusion
There is a lack of reliable data sources and definitions to monitor the epidemiology of sepsis and collect reliable global estimates. Increased policy efforts and new scientific approaches are needed to improve our understanding of sepsis epidemiology, identify vulnerable populations, and develop and target effective interventions.
“…The overactivated immune system attacks the host's tissues and organs, resulting in fever or low body temperature, edema, organ failure, and even death (Gotts & Matthay, 2016; M. Huang et al, 2019). According to the latest global report on sepsis by the World Health Organization, an estimated total of 49 million sepsis cases and 11 million sepsis‐associated deaths occurred in 2017 (Cassini et al, 2020). In 2016, the Center for Disease Control and Prevention estimated that around 1.7 million adult sepsis cases occurred annually in the United States, with around 270,000 deaths (Buchman et al, 2020).…”
Sepsis is a life-threatening condition, and treatment for sepsis in clinic is often not available, partially due to insufficient understanding of the pathogenesis of sepsis.Extensive study to elucidate the pathogenesis is required to improve the clinical management and outcome of sepsis. In this study, we investigated the pathogenesis of sepsis using peripheral blood mononuclear cells (PBMCs) from septic patients and studied the underlying mechanism of miR-16-5p on aerobic glycolysis in lipopolysaccharide (LPS)-treated THP1 and Raw264.7 cells. The levels of RNA and protein were determined by real-time quantitative PCR and immunoblotting assay, respectively. The production of high mobility group box 1 (HMGB1) was measured by enzyme-linked immunosorbent assay. The levels of succinate and lactate were determined using colorimetric kits. The extracellular acidification rate (ECAR) and oxygen consumption rate (OCR) were measured by extracellular flux analyzer. The results showed that the expression of miR-16-5p was elevated, while sirtuin 3 (SIRT3) was decreased in PBMCs from septic patients and LPS-treated cells, along with accumulation of acetylated succinate dehydrogenase complex, subunit A.Concomitantly, an increase in HMGB1, succinate, lactate, as well as ECAR and a decrease in OCR were observed. Knockdown of miR-16-5p upregulated SIRT3 expression, facilitated SDHA deacetylation, and attenuated sepsis-related aerobic glycolysis. Further study identified that SIRT3 is targeted by miR-16-5p, and overexpression of SIRT3 rescued LPS-induced responses via deacetylation of SDHA.Our findings revealed a novel miR-16-5p-regulated SIRT3-SDHA axis in sepsis and provided novel insights for sepsis treatment.
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