Salomão R, Ferreira B L, Salomão M C, Santos S S, Azevedo L C P, Brunialti M K C
Disciplina de Infectologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil.
Departamento de Moléstias Infecciosas e Parasitárias Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil.
Braz J Med Biol Res. 2019;52(4):e8595. doi: 10.1590/1414-431X20198595. Epub 2019 Apr 15.
Sepsis remains a major cause of morbidity and mortality worldwide, with increased burden in low- and middle-resource settings. The role of the inflammatory response in the pathogenesis of the syndrome has supported the modern concept of sepsis. Nevertheless, a definition of sepsis and the criteria for its recognition is a continuous process, which reflects the growing knowledge of its mechanisms and the success and failure of diagnostic and therapeutic interventions. Here we review the evolving concepts of sepsis, from the "systemic inflammatory response syndrome triggered by infection" (Sepsis-1) to "a severe, potentially fatal, organic dysfunction caused by an inadequate or dysregulated host response to infection" (Sepsis-3). We focused in the pathophysiology behind the concept and the criteria for recognition and diagnosis of sepsis. A major challenge in evaluating the host response in sepsis is to characterize what is protective and what is harmful, and we discuss that, at least in part, the apparent dysregulated host response may be an effort to adapt to a hostile environment. The new criteria for recognition and diagnosis of sepsis were derived from robust databases, restricted, however, to developed countries. Since then, the criteria have been supported in different clinical settings and in different economic and epidemiological contexts, but still raise discussion regarding their use for the identification versus the prognostication of the septic patient. Clinicians should not be restricted to definition criteria when evaluating patients with infection and should wisely use the broad array of information obtained by rigorous clinical observation.
脓毒症仍然是全球发病和死亡的主要原因，在资源匮乏的中低收入地区负担加重。炎症反应在该综合征发病机制中的作用支持了脓毒症的现代概念。然而，脓毒症的定义及其识别标准是一个持续的过程，这反映了对其机制的认识不断增加以及诊断和治疗干预措施的成败。在此，我们回顾脓毒症不断演变的概念，从“感染引发的全身炎症反应综合征”（脓毒症-1）到“宿主对感染反应不足或失调导致的严重、潜在致命的器官功能障碍”（脓毒症-3）。我们重点关注脓毒症概念背后的病理生理学以及脓毒症的识别和诊断标准。评估脓毒症中宿主反应的一个主要挑战是区分什么是保护性的，什么是有害的，我们讨论了至少在部分情况下，明显失调的宿主反应可能是为适应恶劣环境所做出的努力。脓毒症识别和诊断的新标准源自可靠的数据库，但仅限于发达国家。从那时起，这些标准在不同的临床环境以及不同的经济和流行病学背景中得到了支持，但在用于识别脓毒症患者与预测其预后方面仍存在争议。临床医生在评估感染患者时不应局限于定义标准，而应明智地利用通过严格临床观察获得的广泛信息。
