Endotoxin: a bona fide treatable sepsis endotype?

IF 2.2 3区医学 Q3 HEMATOLOGY

Blood Purification Pub Date : 2025-05-14 DOI:10.1159/000546294

Hernando Gómez

引用次数: 0

Abstract

Background: The recognition of syndromes has been a pillar of medical education and knowledge. However, treatment of syndromes is challenging because there is a disconnect between the underlying mechanisms that lead to organ injury and the clinical expression of this injury. This is an important barrier to identifying effective treatments in sepsis which may be resolved by the identification of sepsis endotypes.

Summary: In this review we discuss the rationale for considering endotoxic septic shock as a true endotype, the mechanisms by which endotoxin induces cell and organ injury and dysfunction, the strategies to recognize when it occurs and the potential treatments, focusing on endotoxin removal through extracorporeal blood purification.

Key messages: There is sufficient preclinical and clinical evidence to support the notion that endotoxin is a relevant mechanism of injury in human sepsis that drives poor patient outcomes, that can be identified using clinical criteria and biomarkers and that may respond to specific targeted therapies, strongly suggesting that endotoxemic septic shock is a bona fide endotype.

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内毒素：一种真正可治疗的脓毒症内毒素？

背景：辨证已成为医学教育和知识的一个支柱。然而，综合征的治疗具有挑战性，因为导致器官损伤的潜在机制与这种损伤的临床表现之间存在脱节。这是识别脓毒症有效治疗的一个重要障碍，可以通过鉴定脓毒症内型来解决。摘要：本文综述了将内毒素感染性休克视为一种真正的内毒素类型的基本原理，内毒素诱导细胞和器官损伤和功能障碍的机制，内毒素发生时的识别策略和潜在的治疗方法，重点讨论了通过体外血液净化去除内毒素的方法。关键信息：有足够的临床前和临床证据支持内毒素是导致患者预后不良的人类败血症损伤的相关机制，可以使用临床标准和生物标志物进行识别，并且可能对特定的靶向治疗产生反应，这强烈表明内毒素感染性休克是一种真正的内型。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Blood Purification 医学-泌尿学与肾脏学

CiteScore

5.80

自引率

3.30%

发文量

审稿时长

6-12 weeks

期刊介绍： Practical information on hemodialysis, hemofiltration, peritoneal dialysis and apheresis is featured in this journal. Recognizing the critical importance of equipment and procedures, particular emphasis has been placed on reports, drawn from a wide range of fields, describing technical advances and improvements in methodology. Papers reflect the search for cost-effective solutions which increase not only patient survival but also patient comfort and disease improvement through prevention or correction of undesirable effects. Advances in vascular access and blood anticoagulation, problems associated with exposure of blood to foreign surfaces and acute-care nephrology, including continuous therapies, also receive attention. Nephrologists, internists, intensivists and hospital staff involved in dialysis, apheresis and immunoadsorption for acute and chronic solid organ failure will find this journal useful and informative. ''Blood Purification'' also serves as a platform for multidisciplinary experiences involving nephrologists, cardiologists and critical care physicians in order to expand the level of interaction between different disciplines and specialities.