{"title":"内毒素：一种真正可治疗的脓毒症内毒素？","authors":"Hernando Gómez","doi":"10.1159/000546294","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Summary: </strong>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.</p><p><strong>Key messages: </strong>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.</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"1-19"},"PeriodicalIF":2.2000,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Endotoxin: a bona fide treatable sepsis endotype?\",\"authors\":\"Hernando Gómez\",\"doi\":\"10.1159/000546294\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>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.</p><p><strong>Summary: </strong>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.</p><p><strong>Key messages: </strong>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.</p>\",\"PeriodicalId\":8953,\"journal\":{\"name\":\"Blood Purification\",\"volume\":\" \",\"pages\":\"1-19\"},\"PeriodicalIF\":2.2000,\"publicationDate\":\"2025-05-14\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Blood Purification\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1159/000546294\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"HEMATOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Blood Purification","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1159/000546294","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"HEMATOLOGY","Score":null,"Total":0}
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.
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.
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