Abstract
The most recent definition of sepsis in human medicine can be summarized as organ dysfunction caused by a dysregulated host response to infection. In equine medicine, although no consensus definition is available, sepsis is commonly described as a dysregulated host systemic inflammatory response to infection. Defense against host infection is the primary role of innate immune cells known as neutrophils. Neutrophils also contribute to host injury during sepsis, making them important potential targets for sepsis prevention, diagnosis, and treatment. This review will present both historical and updated perspectives on the systemic inflammatory response (SIRS) and sepsis; it will also discuss the impact of sepsis on neutrophils, and the impact of neutrophils during sepsis. Future identification of clinically relevant sepsis diagnosis and therapy depends on a more thorough understanding of disease pathogenesis across species. To gain this understanding, there is a critical need for research that utilizes a clearly defined, and consistently applied, classification system for patients diagnosed with, and at risk of developing, sepsis.
Highlights
THE IMPACT OF SEPSISThe Society of Critical Care Medicine and the European Society of Critical Care Medicine task force define sepsis as life-threatening organ dysfunction caused by a dysregulated host response to infection [1]
The goal of this section of the review is to cover broad topics of neutrophil physiology that are relevant to the pathophysiology of sepsis; the reader is referred elsewhere for details regarding the molecular mechanisms of sepsis and a more detailed examination of neutrophil signaling [10, 128]
It would seem difficult to resolve this observation with the evidence that neutrophil accumulation in tissue is contributing to sepsis-associated organ injury (i.e., multiple organ dysfunction syndrome (MODS), laminitis)
Summary
Documented or suspected infection and some of the following: General parameters: Fever Hypothermia Tachycardia Tachypnea Altered mental status Significant edema or positive fluid balance Hyperglycemia (in the absence of diabetes) Inflammatory parameters: Leukocytosis Leukopenia Normal white blood cell count with > 10% immature forms Plasma C reactive protein >2 SD above normal value Plasma procalcitonin >2 SD above the normal value Hemodynamic parameters: Arterial hypotension Mixed venous oxygen saturation >70% Cardiac index >3.5 1 min−1 m−2 Organ dysfunction parameters: Arterial hypoxemia Acute oliguria Creatinine increase Coagulation abnormalities Ileus Thrombocytopenia Hyperbilirubinemia Tissue perfusion parameters: Hyperlactatemia Decreased capillary refill or mottling scheme proposed for sepsis—called PIRO [Predisposition, Insult, Response, Organ failure (PIRO)]—addressed 4 major areas to stage sepsis in a manner similar to the TNM (Tumor, Lymph Nodes, Metastasis) staging system ((237)) used for oncology patients. It remains to be seen whether the PIRO concept has applications in veterinary medicine
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