Post-mortem diagnostics in cases of sepsis. Part 2. Biochemical and morphological examinations

Rorat, Marta; Simon, Krzysztof

doi:10.5114/amsik.2015.51607

Cited by 5 publications

(10 citation statements)

References 23 publications

(77 reference statements)

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“…Dysregulated inflammatory cytokines release triggers the pathophysiological abnormities of sepsis and multi-system organ failure [32]. To explore the underlying mechanisms of beneficial effect on septic-AKI, the levels of inflammatory cytokines were measured.…”

Section: Discussionmentioning

confidence: 99%

Paeonol protects endotoxin-induced acute kidney injury: potential mechanism of inhibiting TLR4-NF-κB signal pathway

et al. 2016

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Study design and methodsIn order to determine the therapeutic effect and mechanism of paeonol on acute kidney injury induced by endotoxin, an acute kidney injury model was established by intraperitoneal administration of lipopolysaccharide in mice in vivo and on LPS-induced dendritic cells in vitro. Renal tissues were used for histologic examination. Concentrations of blood urea nitrogen and serum creatinine were detected, inflammatory cytokines were determined by ELISA. The relative proteins' expression of TLR4-NF-κB signal pathway was assessed by Western blot, the localization and expression of phospho-NF-κB p65 in kidney was monitored by immunohistochemistry.ResultsTreatment of paeonol successfully cuts histopathological scores and dilutes the concentrations of blood urea nitrogen and serum creatinine as index of renal injury severity. In addition, paeonol reduces pro-inflammatory cytokines and increases anti-inflammatory cytokines stimulated by LPS in a dose-dependent manner. Paeonol also inhibits the expression of phosphorylated NF-κB p65, IκBα and IKKβ, and restrains NF-κB p65 DNA-binding activity. Paeonol treatment also attenuates the effects of LPS on dendritic cells, with significant inhibition of pro-inflammatory cytokines release, then TLR4 expression and NF-κB signal pathway have been suppressed.ConclusionsThese results indicated that paeonol has protective effects on endotoxin-induced kidney injury. The mechanisms underlying such effects are associated with its successfully attenuate inflammatory and suppresses TLR4 and NF-κB signal pathway. Therefore, paeonol has great potential to be a novel and natural product agent for treating AKI or septic-AKI.

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Section: Discussionmentioning

confidence: 99%

Paeonol protects endotoxin-induced acute kidney injury: potential mechanism of inhibiting TLR4-NF-κB signal pathway

et al. 2016

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“…The pathophysiological events underlying sepsis have a strong impact on the function of each organ [ 1 , 3 , 7 ] since the organ failure induced gives rise, in most cases, to morphological alterations that can be evaluated both macroscopically and microscopically. We start by suggesting some works describing the main post-mortem macroscopic and histological changes ( Table 1 ) detected on septic organs [ 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 ].…”

Section: Resultsmentioning

confidence: 99%

“…Finally, external signs may either be absent or vary significantly. As summarized by Rorat et al [ 21 ], signs that can be detected, either on skin or mucosal surfaces, include abscesses, skin discolorations, rashes, or haemorrhagic lesions [ 8 , 19 ], which might testify to the development of a DIC (Disseminated Intravascular Coagulation) or the formation of septic embolisms. Sometimes, more specific lesions might help suggest the cause of sepsis, such as the presence of vesicular and erosive lesions in TEN (Toxic Epidermal Necrolysis) and SSSS (Staphylococcal Scalded Skin Syndrome), or cutaneous cellulitis (peau d’orange) and palpable crepitation in cases of gas gangrene [ 20 ].…”

Section: Resultsmentioning

confidence: 99%

“…Several immunohistochemical markers to date were tested as possible post-mortem markers for the diagnosis of sepsis [ 3 , 4 , 12 , 14 , 21 , 27 , 28 , 29 ]. The lung, representing the mostly impaired organ in sepsis, has rapidly become the main target for immunohistochemical assays in order not only to improve the knowledge of sepsis pathophysiology, but also to establish whether an immunohistochemical marker exists, specific enough to allow a differential diagnosis between sepsis and non-sepsis fatalities within a medico-legal context [ 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 ] ( Table 3 ).…”

Section: Resultsmentioning

confidence: 99%

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Post-Mortem Investigations for the Diagnosis of Sepsis: A Review of Literature

et al. 2020

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To date, sepsis is still one of the most important causes of death due to the difficulties concerning the achievement of a correct diagnosis. As well as in a clinical context, also in a medico-legal setting the diagnosis of sepsis can reveal challenging due to the unspecificity of the signs detected during autopsies, especially when no ante-mortem clinical data, laboratory, and cultural results are available. Thus, a systematic review of literature was performed to provide an overview of the main available and updated forensic tools for the post-mortem diagnosis of sepsis. Moreover, the aim of this review was to evaluate whether a marker or a combination of markers exist, specific enough to allow a correct and definite post-mortem diagnosis. The review was conducted searching in PubMed and Scopus databases, and using variable combinations of the keywords “post mortem sepsis diagnosis”, “macroscopic signs”, “morphology”, “histology”, “immunohistochemical markers”, “biochemical markers”, and “forensic microbiology”. The article selection was carried out following specific inclusion and exclusion criteria. A total of 44 works was identified, providing data on morphological aspects of the organs examined, histological findings, immunohistochemical and biochemical markers, and cultural assays. The review findings suggested that the post-mortem diagnosis of sepsis can be achieved by a combination of data obtained from macroscopic and microscopic analysis and microbial investigations, associated with the increased levels of at least two of three biochemical and/or immunohistochemical markers evaluated simultaneously on blood samples.

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“…Neopterin is a marker of T-cell activation and seems to be associated with SIRS; postmortem serum neopterin was investigated in bacterial and viral infection-related cases as well as in delayed deaths due to trauma [8,28]. A concurrent analysis of neopterin and CRP levels can be useful in the diagnosis of these infections [29].…”

Section: Biomarkers For Sepsis-related Deathsmentioning

confidence: 99%

Sepsis and Nosocomial Infections: The Role of Medico-Legal Experts in Italy

et al. 2019

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Sepsis is a leading cause of morbidity and mortality worldwide. It is defined as the presence of a Systemic Inflammatory Response Syndrome, and it represents a significant burden for the healthcare system. This is particularly true when it is diagnosed in the setting of nosocomial infections, which are usually a matter of concern with regard to medical liability being correlated with increasing economic costs and people’s loss of trust in healthcare. Hence, the Italian governance promotes the clinical risk management with the aim of improving the quality and safety of healthcare services. In this context, the role of medico-legal experts working in a hospital setting is fundamental for performing autopsy to diagnose sepsis and link it with possible nosocomial infections. On the other hand, medico-legal experts are party to the clinical risk management assessment, and deal with malpractice cases and therefore contribute to formulating clinical guidelines and procedures for improving patient safety and healthcare providers’ work practices. Due to this scenario, the authors here discuss the role of medico-legal experts in Italy, focusing on sepsis and nosocomial infections.

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Post-mortem diagnostics in cases of sepsis. Part 2. Biochemical and morphological examinations

Cited by 5 publications

References 23 publications

Paeonol protects endotoxin-induced acute kidney injury: potential mechanism of inhibiting TLR4-NF-κB signal pathway

Paeonol protects endotoxin-induced acute kidney injury: potential mechanism of inhibiting TLR4-NF-κB signal pathway

Post-Mortem Investigations for the Diagnosis of Sepsis: A Review of Literature

Sepsis and Nosocomial Infections: The Role of Medico-Legal Experts in Italy

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