Understanding, Assessing and Treating Immune, Endothelial and Haemostasis Dysfunctions in Bacterial Sepsis

Authors

• Massimo Girardis, Anaesthesiology and Intensive Care Department, University Hospital of Modena, University of Modena, Reggio Emilia, Italy. girardis.massimo@unimore.it.
• Sascha David, Institute of Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland.
• Ricard Ferrer, Intensive Care Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Barcelona, Spain.
• Julie Helms, Université de Strasbourg (UNISTRA), Faculté de Médecine, Hôpitaux Universitaires de Strasbourg, Service de Médecine Intensive-Réanimation, Nouvel Hôpital Civil, Strasbourg, France.
• Nicole P. Juffermans, Department of Intensive Care and Translational Laboratory of Intensive Care, Erasmus Medical Center, Rotterdam, The Netherlands.
• Ignacio Martin-Loeches, Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), St. James' Hospital, Dublin, D08 NHY1, Ireland. Hospital Clinic, Universitat de Barcelona, IDIBAPS, CIBERES, 08180, Barcelona, Spain.
• Pedro Povoa, NOVA Medical School, NOVA University of Lisbon, Lisbon, Portugal. Center for Clinical Epidemiology and Research Unit of Clinical Epidemiology, OUH Odense University Hospital, Odense, Denmark. Department of Intensive Care, Hospital de São Francisco Xavier, CHLO, Lisbon, Portugal.
• Lene Russell, Copenhagen University Hospital Gentofte, Hellerup, Denmark. Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
• Manu Shankar-Hari, Institute for Regeneration and Repair, The University of Edinburgh, Edinburgh, UK. Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, UK.
• Toshiaki Iba, Emergency and Disaster Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.
• Irene Coloretti, Anaesthesiology and Intensive Care Department, University Hospital of Modena, University of Modena, Reggio Emilia, Italy.
• Nicholas Parchim, Division of Pulmonary, Critical Care and Sleep Medicine & Section of Transfusion Medicine and Therapeutic Pathology, University of New Mexico School of Medicine, New Mexico, Mexico.
• Nathan D. Nielsen, Division of Pulmonary, Critical Care and Sleep Medicine & Section of Transfusion Medicine and Therapeutic Pathology, University of New Mexico School of Medicine, New Mexico, Mexico.

Document Type

Article

Publication Date

10-1-2024

Abstract

The interplay between the immune system, coagulation, and endothelium is critical in regulating the host response to infection. However, in sepsis and other critical illnesses, a dysregulated immune response can lead to excessive alterations in these mechanisms, resulting in coagulopathy, endothelial dysfunction, and multi-organ dysfunction. This review aims to provide a comprehensive analysis of the pathophysiological mechanisms that govern the complex interplay between immune dysfunction, endothelial dysfunction, and coagulation in sepsis. It emphasises clinical significance, evaluation methods, and potential therapeutic interventions. Understanding these mechanisms is essential for developing effective treatments that can modulate the immune response, mitigate thrombosis, restore endothelial function, and ultimately improve patient survival.

Recommended Citation

Girardis M, David S, Ferrer R, Helms J, Juffermans NP, Martin-Loeches I, Povoa P, Russell L, Shankar-Hari M, Iba T, Coloretti I, Parchim N, Nielsen ND. Understanding, assessing and treating immune, endothelial and haemostasis dysfunctions in bacterial sepsis. Intensive Care Med. 2024 Oct;50(10):1580-1592. doi: 10.1007/s00134-024-07586-2. Epub 2024 Sep 2. PMID: 39222142.