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

Marshall, John C.; Vincent, Jean‐Louis; Fink, Mitchell P.; Cook, Deborah J.; Rubenfeld, Gordon D.; Foster, Debra; Fisher, Charles J.; Faist, Eugen; Reinhart, Konrad

doi:10.1097/01.ccm.0000065186.67848.3a

Cited by 237 publications

(143 citation statements)

References 46 publications

Supporting

Mentioning

119

Contrasting

Unclassified

Order By: Relevance

“…Another common paradigm in the sepsis field involves a two-phase model consisting of an initial hyper-inflammatory phase followed by a compensatory anti-inflammatory phase, but this has been recently challenged, in large part due to the multiple failures of interventional clinical trials founded on this paradigm [35-37]. Recently, Tang and colleagues [3] conducted a formal systematic review of a carefully selected group of microarray-based human sepsis studies.…”

Section: Genome-level Understanding Of Sepsismentioning

confidence: 99%

“…Viewing septic shock as a highly heterogeneous syndrome implies the existence of 'disease subclasses', in an analogous manner to that encountered in the oncology field [37]. Recently, there has been an attempt to identify septic shock subclasses in children based on genome-wide expression profiling [11].…”

Section: Gene-expression-based Identification Of Septic Shock Subclassesmentioning

confidence: 99%

See 1 more Smart Citation

Clinical review: Sepsis and septic shock - the potential of gene arrays

Wong

2012

Critical Care

View full text Add to dashboard Cite

Over the past decade several investigators have applied microarray technology and related bioinformatic approaches to clinical sepsis and septic shock, thus allowing for an assessment of how, or if, this branch of genomic medicine has meaningfully impacted the field of sepsis research. The ability to simultaneously and efficiently measure the steady-state mRNA abundance of thousands of transcripts from a given tissue source (that is, 'transcriptomics') has provided an unprecedented opportunity to gain a broader, genome-level 'picture' of complex and heterogeneous clinical syndromes such as sepsis. A trancriptomic approach to sepsis and septic shock is technically challenging on multiple levels, but nonetheless modest, tangible advances are being realized. These include a genome-level understanding of the complexity of sepsis and septic shock, identification of novel candidate pathways and targets for potential intervention, discovery of novel, candidate diagnostic and stratification biomarkers, and the ability to stratify patients into clinically relevant, expression-based subclasses. The challenges moving forward include robust validation studies, standardization of technical approaches, standardization and further development of analytical algorithms, and large-scale collaborations.

show abstract

Section: Genome-level Understanding Of Sepsismentioning

confidence: 99%

Section: Gene-expression-based Identification Of Septic Shock Subclassesmentioning

confidence: 99%

Clinical review: Sepsis and septic shock - the potential of gene arrays

Wong

2012

Critical Care

View full text Add to dashboard Cite

show abstract

“…There are promising clinical treatments, such as therapeutic hypothermia, ischemic postconditioning, and controlled reperfusion, which improve survival in preclinical studies and are hypothesized to address postresuscitation metabolic disorders 10, 11, 12, 13. However, there are a number of randomized controlled clinical trials that show no benefit,14, 15, 16, 17, 18 in part as a result of the lack of an ability to differentiate patients with treatable metabolic injury, patients who might live with proper treatment, from patients who do not have a metabolic injury, patients who will live, or from patients with untreatable metabolic injury, patients who will not live 4, 19, 20, 21…”

Section: Introductionmentioning

confidence: 99%

Dissociated Oxygen Consumption and Carbon Dioxide Production in the Post–Cardiac Arrest Rat: A Novel Metabolic Phenotype

Shinozaki

Becker

Saeki³

et al. 2018

JAHA

View full text Add to dashboard Cite

BackgroundThe concept that resuscitation from cardiac arrest (CA) results in a metabolic injury is broadly accepted, yet patients never receive this diagnosis. We sought to find evidence of metabolic injuries after CA by measuring O2 consumption and CO2 production (VCO 2) in a rodent model. In addition, we tested the effect of inspired 100% O2 on the metabolism.Methods and ResultsRats were anesthetized and randomized into 3 groups: resuscitation from 10‐minute asphyxia with inhaled 100% O2 (CA–fraction of inspired O2 [FIO2] 1.0), with 30% O2 (CA‐FIO 2 0.3), and sham with 30% O2 (sham‐FIO 2 0.3). Animals were resuscitated with manual cardiopulmonary resuscitation. The volume of extracted O2 (VO 2) and VCO 2 were measured for a 2‐hour period after resuscitation. The respiratory quotient (RQ) was RQ=VCO 2/VO 2. VCO 2 was elevated in CA‐FIO 2 1.0 and CA‐FIO 2 0.3 when compared with sham‐FIO 2 0.3 in minutes 5 to 40 after resuscitation (CA‐FIO 2 1.0: 16.7±2.2, P<0.01; CA‐FIO 2 0.3: 17.4±1.4, P<0.01; versus sham‐FIO 2 0.3: 13.6±1.1 mL/kg per minute), and then returned to normal. VO 2 in CA‐FIO 2 1.0 and CA‐FIO 2 0.3 increased gradually and was significantly higher than sham‐FIO 2 0.3 2 hours after resuscitation (CA‐FIO 2 1.0: 28.7±6.7, P<0.01; CA‐FIO 2 0.3: 24.4±2.3, P<0.01; versus sham‐FIO 2 0.3: 15.8±2.4 mL/kg per minute). The RQ of CA animals persistently decreased (CA‐FIO 2 1.0: 0.54±0.12 versus CA‐FIO 2 0.3: 0.68±0.05 versus sham‐FIO 2 0.3: 0.93±0.11, P<0.01 overall).Conclusions CA altered cellular metabolism resulting in increased VO 2 with normal VCO 2. Normal VCO 2 suggests that the postresuscitation Krebs cycle is operating at a presumably healthy rate. Increased VO 2 in the face of normal VCO 2 suggests a significant alteration in O2 utilization in postresuscitation. Several RQ values fell well outside the normally cited range of 0.7 to 1.0. Higher FIO 2 may increase VO 2, leading to even lower RQ values.

show abstract

“…A avaliação da qualidade e da intensidade da resposta infl amatória pode levar a identifi cação de pacientes em risco de disfunção de órgãos 6 . Um bom indicador para sepse deve fazer mais do que prever sobrevida dos pacientes, deve guiar o tratamento e revelar a sua resposta 12 . Não existe um indicador isolado capaz de prover esta informação, o mais provável é que seja necessário um conjunto de indicadores de infl amação e imunossupressão 6 O desenho do estudo foi do tipo caso-controle aninhado a uma coorte prospectiva e observacional, onde foram incluídos, de forma consecutiva, todos os pacientes adultos que apresentavam sepse no momento da internação na UTI ou desenvolvida após a admissão, no período de agosto a dezembro de 2004.…”

Section: Introductionunclassified

Fatores de risco associados à mortalidade em pacientes com sepse em unidade de terapia intensiva de hospital privado de Pernambuco

Koury¹,

Lacerda²,

Neto³

2007

Rev. bras. ter. intensiva

View full text Add to dashboard Cite

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

Abstract: Advances in the understanding and management of patients with sepsis will necessitate more rigorous approaches to disease description and stratification. Models should be developed, tested, and modified through clinical studies rather than through consensus.

Cited by 237 publications

References 46 publications

Clinical review: Sepsis and septic shock - the potential of gene arrays

Clinical review: Sepsis and septic shock - the potential of gene arrays

Dissociated Oxygen Consumption and Carbon Dioxide Production in the Post–Cardiac Arrest Rat: A Novel Metabolic Phenotype

Fatores de risco associados à mortalidade em pacientes com sepse em unidade de terapia intensiva de hospital privado de Pernambuco

Contact Info

Product

Resources

About